Fistula First Breakthrough Initiative (FFBI)

The national Fistula First Breakthrough Initiative (FFBI) represents a joint effort between ESRD Networks, CMS, and the Institute for Healthcare Improvement (IHI). The purpose of the project is to improve quality in the area of vascular access, specifically by increasing the proportion of patients who dialyze via AV fistula (AVF).  A preponderance of medical literature exists, and will not be reiterated here, providing convincing evidence that the AVF is the preferred access based on low complication rates, longevity, and low costs.  Further, the National Kidney Foundation K-DOQI Practice Guidelines establish a goal that at least 65% of incident and at least 40% of prevalent hemodialysis patients should dialyze by AVF.  Fistula proponents maintain that a much higher rate can be achieved, which has in fact been demonstrated in some areas.

The CMS target for AVFs is 66%.

The March 2012 AV Fistula Goal for Network 5 is 57.3%.

As of January 2012, Network 5's AV fistula rate was 58.0%! 

As of October 2011 Network 5 had exceeded both the national goal of 57.3% for our network and our stretch goal -- five (5) months early!! 

Accountable Leadership Collaborative

Accountable Leadership Collaborative facilities are facilities that have been indentified to participate in a focused quality improvement project.  This project will help facilities focus on increasing their AVF rates and decreasing their CVC rates.

Benchmark Facilities

Benchmark facilities are the top-performing facilities in the area of AVF utilization, providing care to 10% of patients in Network 5. Top performers are identified using the Achievable Benchmarks of Care (ABCTM) methodology developed at the University of Alabama.

Recognition Program

Each quarter, the Network assesses and classifies facilities according to their AVF rate maintained for a 3-month period. As the overall Network AVF average rises, we will continue to recognize facilities that achieve rates above the average. Guidelines for the 2011 Fistula First Recognition Program follow:

• STUPENDOUS SIXTIES Facilities must achieve an AVF rate of 60 to 69.9% (maintained for 3 consecutive months)
• SIZZLING SEVENTIES Facilities must achieve an AVF rate of 70 to 79.9% (maintained for 3 consecutive months)
• EXEMPLARY EIGHTIES Facilities must achieve an AVF rate of 80 to 89.9% (maintained for 3 consecutive months)

Fistula First Recognition Program Facilities

2011
3rd Quarter
2nd Quarter
1st Quarter

2010
4th Quarter 
3rd Quarter 
2nd Quarter
1st Quarter

Improving Your Facility's AVF Rate

If your facility is in Virginia, West Virginia, Maryland, or Washington, DC, we can help you improve your rates! Download an order form or contact us to obtain the following materials. If you are located outside of the Network 5 area, please contact the ESRD Network for your state for Fistula First materials.  

Fistula First Change Concepts

For Physicians
The Facility Feedback Report provides information on each facility's Fistula First performance, as well as suggestions on how to improve fistula rates. The report is mailed monthly to the head nurse of each Network 5 facility with additional copies for distribution to the facility's medical director, administrator, and nephrologists.

For Facility Staff
The Facility Feedback Report provides information on each facility's Fistula First performance, as well as suggestions on how to improve fistula rates. The report is mailed monthly to the head nurse of each Network 5 facility with additional copies for distribution to the facility's medical director, administrator, and nephrologists.

In-Service Training Module #4: Fistula First (available in hard copy upon request)

Cannulation Protocol for New Fistulas Use these guidelines to establish your own facility protocol.

For Patients
Planning Ahead for a Fistula, a comprehensive list of patient resources for vascular access (compiled as part of the Fistula First Breakthrough Initiative)

Information Card for Patients (3 1/2" x 8 1/2" card for patients about advantages of an AV Fistula)

Dialysis Patients Speak: A Conversation about the Importance of AV Fistulas (DVD & VHS)

Your Access to Success (DVD & VHS)

Vascular Access for Hemodialysis (VHS only)

For Surgeons
Creating AV Fistulae in All Eligible Hemodialysis Patients (DVD only)

Additional Resources

National Fistula First Breakthrough Initiative website