Quest Demo - (Page 10) daTa and oUTComES mEaSUREmEnT STRaTEGY In tracking the progress of this initiative, one challenge was to ensure timely and accurate measurement of AVF, as well as AVG and CVC, rates in all dialysis facilities over time as the Change Package was introduced and utilized. Rates of AVF use in individual facilities, aggregated to reflect corporate, state, network and national rates, provide a direct and comprehensive picture of the adoption of the Change Package, as well as outcomes, throughout the entire practicing community. In the past, networks collected annual data from the ESRD Clinical Performance Measures Project annual reports and the Centers for Disease Control and Prevention annual survey of dialysis facilities; however, this was too infrequent, not reflective of current practice and not specific enough to provide actionable feedback to medical specialists and dialysis facilities. Although dialysis providers themselves routinely collect access data, a lack of common methods and definitions prevented simple compilation of data for broad comparisons and reliable feedback. A standardized data collection tool was developed by the FFBI, which was implemented in early 2004. The large dialysis organizations (LDOs), representing about two-thirds of all U.S. dialysis facilities, now supply data electronically on a monthly basis to CMS in support of this project. Other facilities provide data monthly using an electronic spreadsheet through their ESRD Networks. The monthly data are then summarized in the Fistula First Outcomes Dashboard (available from ESRD Networks) and used to track improvement in AVF incident and prevalent rates at the network and national levels. FFBI aCComPLIShmEnTS Some examples of the accomplishments and spread strategies of the FFBI in overcoming longstanding barriers to improvement include: • a specific website to provide AVF information, resources, tools and answers to specific questions (www.fistulafirst.org) 10 • a new national data collection system to permit real-time access and analysis of vascular access-related data • collaboration with the KDOQI work group • a comprehensive surgical education and training program (video series) currently available on the Fistula First website and through the ESRD Networks • ongoing local, regional and national educational meetings for physician groups • regional AVF surgical workshops sponsored by ESRD Networks throughout the country • a cannulation education and training video for dialysis staff, available at no charge through the ESRD Networks or the Fistula First website • a new billing code (G-0365) established by CMS specifically for reimbursement for AVF vessel mapping • a comprehensive list of educational resources for chronic kidney disease patients and families, available on the Fistula First website • a series of position papers and recommendations for practitioners and organizations related to AVF improvement • a marketing package to spread the message of the initiative to patients and providers • the enlisting of AVF “Champions” in all disciplines to speak locally as well as throughout the country • a vessel mapping protocol and educational material • on-site as well as off-site assistance and mentoring by local ESRD Networks • availability of members of the work group, to provide their expertise and assistance via communication through the website oUTComES To daTE: a-V FISTULaS and CEnTRaL VEnoUS CaThETERS As the ESRD community responded to this AVF call to action and began to adopt the FFBI Change Concepts into practice, a trend of increased AVF use ensued. In the four years since the rollout of the initiative, the prevalence of AVFs in use has increased from 32% to almost 49%, representing an increase of 50%. A number of publications written since the launch of the FFBI have http://www.fistulafirst.org
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.