Original InvestigationDialysisAchieving the Goal of the Fistula First Breakthrough Initiative for Prevalent Maintenance Hemodialysis Patients
Section snippets
Study Setting
The 18 regional ESRD Networks make up a surveillance system that collects, analyzes, and disseminates information about the patterns and outcomes of ESRD care in the United States. The networks are responsible for conducting the FFBI and, in collaboration with dialysis facilities, nephrologists, and other health professionals, improving the use of AVFs by US HD patients. Networks are CMS contractors responsible for communicating the advantages of AVF use, providing improvement strategies and
Results
There were 5,692 facilities submitting data to the CMS vascular access database for January 2007-April 2010, and 4,064 had an average patient census of 10 or more and data for all 40 months. Six facilities were excluded because of coding anomalies (ie, having >1 network number). Of the remaining 4,058 facilities included in our analyses, mean patient census was 72.3 ± 42.4 (standard deviation). Table 1 provides a description of facility case-mix and other characteristics across networks.
AVF use
Discussion
Although the CMS goal of 66% prevalent AVF use has not yet been reached nationally, our observations, which are based on national monthly reporting by all FFBI-eligible facilities in the United States, show that the goal frequently is attained by individual facilities; however, success varies substantially among facilities in different networks. Because of the shared responsibility for improvement by facilities and networks, it is useful to examine progress and consider additional strategies
Acknowledgements
The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
Support: The analyses upon which this publication is based were performed under Contract number 500-06-NW005C entitled ESRD Networks Organization for the District of Columbia, Maryland, Virginia, and West Virginia, sponsored by the CMS, Department of Health
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Originally published online December 1, 2010.