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 and Medicaid Services (CMS) is pleased to announce an important new initiative called “Fistula First,” aimed at significantly increasing the use of AV fistulas (AVF) for hemodialysis access. The initiative will engage nephrologists, vascular surgeons, dialysis facilities, primary care physicians, and patients in changing practice to assure that AVFs are the first choice for every eligible patient.

March 17, 2005

The Centers for Medicare and Medicaid Services (CMS) in close collaboration with key stakeholders in the renal community, announced the launch of Fistula First, to achieve “breakthrough” improvements in the use of safe vascular access and promote the placement of AV Fistulas in all suitable hemodialysis patients. This is the first in a series of collaborative Breakthrough Initiatives targeting critical areas of opportunity for rapid health care improvement, leading to significantly better health for millions of Medicare beneficiaries and lower costs for the Medicare program.

Full press release at: http://www.cms.hhs.gov/
media/press/release.asp
?Counter=1386

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?

The Fistula First project aims to fulfill the goals recommended by the Foundation’s Kidney Disease Outcomes Quality Initiative: AVF rates of 50% or greater for incident, and at least 40% for prevalent patients undergoing hemodialysis. This constitutes a significant increase over current national averages, which are 29% for incident patients and 31% for prevalent patients.

5	31.7	Source: Esource January 2005 Click Here to View Network Map
8	31.8
13	32.9
14	33.1
11	35
9	35.2
6	35.3
12	36.4
10	36.7
4	37.1
US	37.8
3	37.9
7	39.1
17	41.3
18	41.6
2	45
1	45.6
15	45.7
16	56.7

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.

More >>