Fistula First National Vascular Access Improvement Initiative

A video training program for surgeons and interventionalists

Developed by William Jennings, MD and Lawrence Spergel, MD and hosted by the University of Oklahoma Health Science Center.

The Centers for Medicare & Medicaid (CMS), in close collaboration with key stakeholders in the renal community, is pleased to introduce an initiative called “Fistula First”. The purpose is to significantly increase the use of AV fistulas (AVF) as the primary vascular access in all suitable hemodialysis patients.

Click here for more information on the Fistula First Breakthrough Initiative Coalition
Click here to read original CMS Press Release

March 2007: Thanks to the dedication and hard work of all of the renal stakeholders in the national Fistula First Breakthrough Coalition, the original K-DOQI and Fistula First goal of 40% fistulas in prevalent hemodialysis patients was achieved in August 2005! The original target date for achieving this level was June 2006. As of March 2007, the prevalent rate is 45%.

Click Here to read an interview with Lawrence Spergel, Fistula First
Project Clinical Chair.
“Why is a Vascular Access Initiative Important?”

Where should I begin if I work at a Dialysis Facility?
Where should I begin if I am a Nephrologist?
Where should I begin if I am a Surgeon?
Where should I begin if I am an Interventionalist?

AV Fistula First is a coalition working to increase the use of AVFs by individuals who need hemodialysis. We are working together to meet KDOQI guidelines and the CMS stretch goal of increasing the percentage of hemodialysis patients using AVFs to 66% by 2009 nationwide. As of 2007, 45% of hemodialysis patients use AVFs, which is a 30% increase in AVF use rates since the initiative began in 2003.

Click Here to View Current Data
Click Here to View Network Map

A change concept is a general approach to change that has shown usefulness in developing specific ideas for changes that lead to improvement. Change concepts are intended to encourage development of specific changes that make sense within a particular setting. Eleven change concepts have been identified to help the renal community improve the rate of AV fistulas.

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