Fistula First Breakthrough Initiative Provides Roadmap to Reach Goal of 66%
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the Fistula First Breakthrough Initiative (FFBI) has released a strategic plan that aims to achieve CMS' goal that two-thirds (66%) of prevalent hemodialysis patients will use an arteriovenous (AV) fistula as their primary method of vascular access.
The FFBI Strategic Plan focuses on seven strategies and two policy recommendations. The plan was developed by conducting a root-cause analysis that identified the underlying barriers to AV fistula placement and use. A technical expert panel identified potential solutions to address the root causes.
Led by the FFBI Coalition, with support from the End-stage Renal Disease (ESRD) Network Organizations and the Quality Improvement Organizations (QIOs) under CMS' leadership, the Strategic Plan includes the following concepts:
- Nephrologist as Leader: Encourage and support nephrologists to take a leadership role and be accountable for vascular access management in all hemodialysis patients.
- Leveraging Partnerships: Partner with organizations to improve AV fistula placement and utilization rates.
- Hospital Systems: Modify hospital systems to promote AV fistula placement.
- Patient Self-Management: Promote patient self-management through the stages of Chronic Kidney Disease.
- Addressing Access Problems: Promote fast-track protocols for rapid identification and referral of vascular access problems, which include failure to mature, revisions of the failing AV fistula, and failure to place an AV fistula.
- Practitioner Training and Credentialing: Promote training, experience, and credentialing of healthcare professionals in the area of hemodialysis vascular access management.
- FFBI Change Concepts: Expand and endorse the current Change Concepts for education and promotion throughout the renal, surgical, and interventional communities.
The percentage of prevalent hemodialysis patients in the U.S. with an AV fistula as their primary vascular access was 32.4% (87,344 patients) at the beginning of 2003. By May 2009, this percentage had increased to 52.6% (179,113 patients). As a result, nearly 92,000 additional patients experienced improved adequacy, fewer hospitalizations, fewer infections, and a lowered mortality risk than those with other forms of vascular access. The dramatic change in practice patterns that produced the improvement was due to the targeted efforts of many organizations and individuals, facilitated by the Fistula First Breakthrough Initiative. However, the CMS goal, based upon achievable practice, is a prevalent AV fistula utilization rate of 66%, which means that there are additional opportunities for improvement.
The FFBI Strategic Plan presents recommendations for accountability and organizational, behavioral, and infrastructural changes across healthcare systems which, if implemented, will result in sustainable outcomes improvement.
To read the FFBI Strategic Plan online, please visit http://www.fistulafirst.org 
on the Internet. To learn more about the portfolio of CMS' ESRD quality projects online visit, http://www.cms.hhs.gov/ESRDQualityImproveInit/ on the CMS Website.
Page Last Updated: Thursday, 18-Mar-2010 05:54:52 CDT
