About Us

"I have had CKD/ESRD since 1982. I have been on hemodialysis, had a transplant, then went back to peritoneal dialysis. I'm currently on hemodialysis. It was not until I ran out of options that I took a chance on an AV fistula. I wish I had done it sooner. It has worked well for me and is much better that having to worry about a catheter."
    - Celeste L., AV Fistula Patient

The AV Fistula First Breakthrough Coalition (FFBI), consisting of the Centers for Medicare & Medicaid Services (CMS), ESRD Networks, and the entire renal community, works together to increase the likelihood that every suitable patient will receive the most optimal form of vascular access - which, in most cases, will be a native arteriovenous fistula, or AVF. The focus of the FFBI is also on reducing catheter use and vascular access complications.

The project has brought together the best of what is known about improving vascular access. By harnessing the knowledge of the many disciplines whose care influences vascular access choices for patients, the FFBI Coalition model has created a new level of cooperation across professional disciplines and care settings. The project also supports the ESRD Networks in enhancing their own improvement capabilities, and in transferring useful improvement skills to facilities and medical specialists. The Networks have used their collective knowledge and experience in new and expanded ways to generate significant national progress around this important issue.

Principles for Change

AV Fistula First aims to build on prior work, and has taken advantage of system-level diagnosis and strategies for improvement. The following list summarizes the key principles that governed the development of "change strategies" for the project:

1. Core strategies and tools that address the fundamental "failure" points in the system that can be adopted easily.
2. Focus on "spreading" successful ideas on a Network and national scale.
3. Collaboration – among patients, Networks, providers and key health professionals.
4. Leveraging of resources, including Network QI resources and other relevant sources of expertise and support from the Coalition membership.
5. Minimizing burden on dialysis facilities and practitioners

Mission Statements and Activities of the AV Fistula First Breakthrough Coalition Groups

This project has developed around several working groups, or Task Forces, that collectively address specific issues related to improving AVF rates. Each group has produced its own mission statements and activities that provide ongoing input and support to the AV Fistula First project.