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Fistula First

This 3-year National initiative (2003-2006) is being undertaken to improve vascular access for end-stage renal disease (ESRD) patients, with the specific goal of increasing the placement and utilization of arteriovenous fistulas (AVF) as primary vascular access for hemodialysis.

The mission of "FISTULA FIRST" is to make sure that every eligible ESRD patient will receive the most optimal form of vascular access for that patient (in the majority of cases an AVF), and to avoid vascular access complications through appropriate monitoring and intervention. One of the goals is to make significant progress toward attaining Clinical Performance Measures (CPM) and K/DOQI™ standards for AVF placement and use by June 2006.

The current resources for the "FISTULA FIRST" initiative include:

• INITIATIVE OVERVIEW - CMS and the 18 ESRD Networks announcement of the "FISTULA FIRST" Initiative
  
  
• "FISTULA FIRST" CHANGE PACKAGE - Eleven key strategies for increasing AVF's. These concepts are intended to encourage specific changes that make sense within your clinical setting.
  
  
• 'WHAT TO CONSIDER WHEN REVIEWING A CHANGE PACKAGE?'
  
  
  1. Which of these strategies are already being done?
     
     1. Can any of these strategies be strengthened?
        
        
  2. Which new change could be made that would cause an improvement?
     
     
  3. Where will adopting a change require new ways of working (e.g., communication, coordination, clinical skills)?
     
     
  4. Will any changes require new clinical skills?
     
     
  5. What kind of knowledge and support may be needed and where can it be found?
     

A variety of activities have been undertaken and remain underway, by Network 13 to work with the various health care professionals involved in the vascular access care of a hemodialysis patient.

1. Physician conferences and Grand Rounds have been held throughout the Network. Those presentations are available via this Web site.
   
   
2. The Fistula First QI tool kit have been developed and distributed to all dialysis facilities in the Network. These are "tools you can use" to improve the placement and utilization rates specific to fistulas. These tools are available on this Web site or you can contact the Network for hard copies and/or CD’s.
   
   
3. Data collection tools have been distributed to all non-LDO dialysis facilities and can be utilized for facility-specific quality improvement activities.
   
   
4. We are glad to report that 98% of the Network 13 dialysis facilities are actively involved in this initiative. Please check back here often for updates on initiative activities.
   

As of May 2008
Network 13 Fistula Utilization Rates is 48.0%.

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