University of Missouri - Saint Louis

The Graduate School


An oral examination in defense of the final project for the degree

Doctor of Nursing Practice

Christopher R. Hemmer
M.S. in Nursing, December, 1999, University of Missouri-St. Louis.
B.S. in Nursing, May, 1994, Southeast Missouri State University.

Identification and Management of Vertebral Column Fractures in Primary Care


The purpose of this project is to perform a program evaluation of current treatment patterns of primary care providers for osteoporotic vertebral compression fractures (VCF). VCF’s result in significant morbidity and long term sequelae following a VCF is not uncommon. Additionally, there is controversy regarding the diagnosis and management of this disorder, especially as these relate to the clinical practice guidelines.

This practice evaluation project included a pre and post-test survey and a continuing education offering. Thirty-nine physicians and nurse practitioners completed the survey instruments and attended the continuing education sessions. The educational session resulted in improvement of the provider’s comfort level and understanding of vertebral column fracture identification and management (F=4.709, df=4, p=0.004). Eighty-two percent of the respondents were unfamiliar with the current practice guidelines for compression fractures prior to the educational session. The post survey response to changing practice pattern after continuing education was 71.8%. Of note, there was a significant difference in the use of clinical practice guidelines between physicians and nurse practitioners (F=5.941, df=4, p=0.001)).

The information obtained from this project could be used as a spring board for a large scale project. Further study is needed to determine if these results are reproducible in other settings and with larger more heterogeneous samples. Additionally, the statistically significant difference between physicians and nurse practitioners use of the current practice guidelines merits further research. Nonetheless, preliminary findings suggest that continuing education can improve primary care providers understanding of vertebral column fractures in the short term.


Date: November 14, 2012

Time: 11:30am 12:00pm

Place: College of Nursing Administration Building, Conference Room 1


Defense of Final Project Committee


Dawn Garzon, Ph.D.(Advisor)

Joanne Thanavaro, DNP


Shelly Hanko, Ph.D.

Yakima Young-Shields, MSN