Measures for Vascular Access:
Fistula Use Rates in Hemodialysis Patient

Track the vascular access types (AV fistulae, AV grafts, and catheters) being used by your hemodialysis patients on a monthly basis. Track rates of fistula use for both incident (new) and prevalent (existing) patients.

Goal:

Use the recommendation of the CMS ESRD Clinical Performance Measures (CPM) project and the Kidney Disease Outcomes Quality Initiative (K/DOQI) practice guidelines to set your goal. The recommendation is that 40 percent of all prevalent patients and 50 percent of all incident patients undergoing hemodialysis should be dialyzing with a native AV fistula. If your rate is below this recommendation, set your goal to reach it within a specified time period.

Examples:

• Improve the rate of fistula use in prevalent patients from 35 percent to 40 percent in 18 months.
• Improve the rate of fistula use in prevalent patients from 25 percent to 33 percent in 18 months and to 40 percent in three years.
• Improve the fistula-placement rate for incident patients from 30 percent to 40 percent in 18 months and to 50 percent in three years.

If your rates are close to or above the recommendation, set a reasonable stretch goal to achieve it within a specified time period.

Examples:

• Improve the rate of fistula use in prevalent patients from 42 percent to 47 percent in 18 months.
• Improve the fistula-placement rate for incident patients from 48 percent to 52 percent in 18 months and to 56 percent in three years.

Fistula First Data Collection Tool
This can be used to collect data on the type of vascular access used for a dialysis treatment. The tool is designed for use at the facility level, but could also be used by an individual physician or physician group. Collect data on the type of access used as of the last day of treatment in the month. The tool distinguishes between patients who are using a temporary access while a permanent one matures, and patients starting dialysis with only a single access.

The tool also contains a patient log and a facility summary. The facility summary contains the key metrics for tracking fistula rates in prevalent patients at the facility level. Many facilities, especially those that are part of Large Dialysis Organizations (LDOs), have the capability to provide this summary data electronically. The VATT can be useful for those facilities that do not have this capability. This data can be stratified to provide individual clinician performance levels. The summary data can then be plotted on a time-series graph (or run chart) monthly to monitor performance.

Dialysis facilities will be reporting their access data directly to their ESRD Network. Physicians wishing to track their fistula rates could use the tool to collect data for their own patients.

Download FF data collection tool and instructions:
Data collection tool - patients
Data collection tool - aggregate

Download current national FF data -- Dashboard

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