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Fistula First

ESRD National Vascular Access Improvement Initiative (NVAII) began in 2003 through a partnership of the Centers for Medicare & Medicaid Services (CMS), the Institute for Healthcare Improvement (IHI), ESRD Networks, and various other organizations. The initial 3-year project (2003 - 2006) sought to improve vascular access for dialysis patients by increasing arterial venous fistula (AVF) use. K-DOQI guidelines state that AVF should be the access for at least 50% of incident and 40% of prevalent hemodialysis patients.

At the beginning of this program in October 2003, Network 11 had 31.3% of prevalent hemodialysis patients with an AVF, as compared to 32.4% nationally. Since that time, CMS has named the Fistula First project as a Break-through Initiative to give additional national focus and visibility to this important project. Nationally, AVF prevalence has improved by almost 16% through the collaborative efforts of numerous organizations.

Network 11 is using a multi-faceted approach to improve AVF incidence and prevalence rates. This approach has incorporated the collaboration and partnership with the dialysis community, including providers, vascular access surgeons, nephrologists, and patients. Organizations such as: state survey agencies, quality improvement organizations, payors, and others, have also partnered in this project. Overall, Network 11 has achieved greater than 15% improvement in AVF prevalence, as shown below.

CMS has set new goals for each ESRD Network in order to reach 66% AVF prevalence nationally by 2009. Network 11's goal is to improve AVF prevalence by 4% annually over the next 3. To progress toward this goal, Network 11 will continue to work with the renal community and other partners to develop new tools and resources to achieve a Fistula First in every eligible patient in Network 11.

Upcoming Events

• Facility Feedback Reports, August 2008

Resources

• Network 11 Fistula First Newsletters
• Patients
• Nephrologists and Surgeons
• Dialysis Facilities

Tools

• NVAII Change Package
  A multi-disciplinary working group, chaired by vascular access surgeon Lawrence Spergel, MD, developed this set of change concepts for increasing AV fistula use among hemodialysis patients in the United States.
• Dialysis Facilities: Improvement Strategies
• Dialysis Facilities: Vascular Access Monitoring and Tracking
• Tools for Nephrologists and Surgeons
• Patient Education

Data Trends

Each month, Computer Sciences Corporation (CSC) produces a national dashboard that compares both AVF prevalence and incidence across ESRD Networks. In addition to this national dashboard, Network 11 produces a dashboard monthly that shows current vascular access trends on both a local and regional level. This page contains links to current national and regional data trends.