MISSION STATEMENT

The Centers for Medicare & Medicaid Services (CMS), ESRD Networks, the renal community, and the Institute for Healthcare Improvement (IHI) will work together to increase the likelihood that every eligible patient will receive the most optimal form of vascular access for that patient (in the majority of cases an arterial venous fistula, or AVF), and that vascular access complications will be avoided through appropriate access monitoring and intervention.

The intent is for CMS, the ESRD Networks and the renal community to reach or surpass the goals set forth in the CMS Clinical Performance Measures project, that is, regional and national AVF rates of 50% or greater for incident patients, and at least 40% for prevalent patients undergoing hemodialysis. CMS has committed to a system-wide improvement project on vascular access over the course of the three-year ESRD Network contract, starting July 2003. CMS and the Networks will aim to ensure that every ESRD Network meets or exceeds its specific goal for vascular access improvement over the term of the 2003 Network contract.

The project will bring 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, we aim to create a new level of cooperation across professional disciplines and care settings.

The project will also support the ESRD Networks in enhancing their own improvement capabilities, and in transferring useful improvement skills to facilities and medical specialists. We envision the Networks using their collective knowledge and experience in new and expanded ways to generate significant national progress around this important issue.

GOALS

Goals for the work that are consistent with this mission include:

1. The US renal care system as a whole will make significant progress toward attaining CPM and K/DOQI goals for AVF use (50% incidence; 40% prevalence) by the end of current Network contract period (June 2006).
2. Several Networks will meet or exceed the goal of 50% AVFs for incident patients by the end of the contractual period
3. Several Networks will meet or exceed the goal of 40% AVFs for prevalent patients by the end of the contractual period.
4. Networks that are currently operating at, or close to, the minimum standard for AVF use will establish stretch goals based on assessment of maximum feasible use of AVFs in their patient populations, and will make significant progress in meeting those stretch goals by the end of the contractual period.
5. All Networks will reduce to zero the number of patients with catheters or grafts who have not been appropriately assessed for possible AVF placement.

PRINCIPLES FOR DEVELOPING CHANGE STRATEGY

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

1. Core strategies that address the fundamental “failure” points in the system and are operational enough to be adopted with manageable levels of external support.
2. Focus on “spread” of successful ideas on a Network and national scale.
3. Collaboration – among Networks, providers and key health professionals.
4. Leveraging of resources, including Network QI resources and other relevant sources of expertise and support.
5. Minimize burden on dialysis facilities.