Change Concept #11 Facilities can start by measuring performance on a monthly basis by access type — catheter, AV graft, and AV fistula — since access type is the major determinant of outcomes and directly affects dialysis delivery and adequacy. It is also important to focus specifically on native AV fistula outcomes and performance, including tracking the monthly AV fistula placement and failure rate in incident as well as prevalent patients. The National Vascular Access Improvement Initiative (NVAII) has developed a data collection tool (Vascular Access Tracking Tool (VATT) and Instructions) that can help facilities measure and track AV fistula rates (and all access types) in incident and prevalent patients. This data tool permits simple tracking of not only AV fistulae that are in use but also AV fistulae that have been placed and are awaiting maturation. Performance outcomes for specialists (surgeons, nephrologists, and interventionalists) should also be tracked and reported to everyone on the team on a regular basis: For surgeons, track the AV fistula placement rate (compared to K/DOQI standards) as well as success and patency rates.
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