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Change Concept #11
Outcomes Feedback to Guide Practice
Facilities can start by measuring performance on a monthly basis by access type - catheter, AV graft, and AV fistula - since access type is the major determinant of outcomes and directly affects dialysis delivery and adequacy. It is also important to focus specifically on native AV fistula outcomes and performance, including tracking the monthly AV fistula placement and failure rate in incident as well as prevalent patients.
The
National Vascular Access Improvement Initiative (NVAII) has developed a data collection tool (Vascular Access Tracking Tool (VATT) and Instructions) that can help facilities measure and track AV fistula rates (and all access types) in incident and prevalent patients. This data tool permits simple tracking of not only AV fistulae that are in use but also AV fistulae that have been placed and are awaiting maturation.
Performance outcomes for specialists (surgeons, nephrologists, and interventionalists) should also be tracked and reported to everyone on the team on a regular basis:
For surgeons, track the AV fistula placement rate (compared to K/DOQI standards) as well as success and patency rates.
- For nephrologists, track the distribution of access types their patients receive, with a focus on the AV fistula rate and the percentage of new patients starting dialysis with only a catheter.
- For interventionalists, measure the success rate of interventions and track patency rates for their procedures.
Changes for Improvement
Frequently Asked Questions
Related Literature
Related Tools
Related Resources
Changes for
Improvement:
Provide Specific Outcomes Feedback to All Decision Makers
Provide specific outcomes feedback to all decision makers, including incident and prevalent rates of AV fistula, AV graft, and catheter use.
The ESRD Networks are currently working with dialysis providers to collect and provide this information regularly to each facility.
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Changes for
Improvement:
Review Data Monthly or Quarterly in Facility Staff Meetings
Discuss and evaluate data trended over time for incident and prevalent rates of AV fistula, AV graft, and catheter use. Track and disseminate all vascular access-related outcomes.
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