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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 over 22% 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 nearly 22% improvement in AVF prevalence, as shown below.

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.