Measures for Vascular Access

The proposed measurement strategy for vascular access was designed to support improvement activities at the dialysis facility level. However, individual physicians and physician practices may also find it useful. The aims in developing the strategy were as follows:

• Focus on relevant process and outcome measures that will be useful at the facility and provider levels
• Simplicity and ease of use
• Fast collection and straightforward analysis so that data can be tracked monthly

These measures tell you whether changes are really leading to improvement - that is, helping to achieve the aim of increased fistula use for hemodialysis patients. The key outcome measures are fistula use rates in prevalent (existing) hemodialysis patients and fistula placement rates in incident (new) patients.

Process Measures

To increase the percentage of patients using fistulas, teams must make changes in clinical and organizational processes. Process measures tell teams if they are making progress in implementing these changes. Examples of process measures include progress in implementing the following: investigation of all non-AV fistula (AVF) accesses as part of continuous quality improvement (at the facility level); the specification of "AVF only" in referral to surgeons for evaluation and placement (nephrologists).

Balancing Measures

Use these measures to assure that changes to improve one part of the system aren’t causing new problems in other parts of the system. Measures (for example, adequacy, anemia) that monitor performance of hemodialysis should be tracked closely.

>> Fistula Use Rates in Hemodialysis Patients