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Background
Based on the 2008 Clinical Performance Measures (CPM) Project data collection sample (data from 4th quarter 2007), the measured Percent Patients with Arteriovenous Graft (AVG) and Stenosis Monitoring for Network 5 was 58%, compared with a national average of 71%. While the CPM Project collects data on surveillance activities, the resulting measure is termed Percent Patients with AVG and Stenosis Monitoring. The K-DOQI clinical practice guidelines distinguish between monitoring and surveillance:
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Monitoring is defined as “the examination and evaluation of the vascular access by means of physical examination to detect physical signs that suggest the presence of dysfunction.”
The 2009-2010 Stenosis Surveillance Project will be looking at surveillance activities though the CPM measure employs the term "monitoring."
Guidelines have changed in recent years, and currently accepted methods of stenosis surveillance include:
- Color-flow Doppler at least once every three (3) months,
- Static Venous Pressure at least once every two (2) weeks, and
- Dilution Technique at least once every three (3) months.
Because the AVG stenosis surveillance measure is based on a sample of patients, it is impossible to identify the AVG stenosis surveillance rates for individual facilities. Facilities targeted for inclusion in the 2009-2010 Stenosis Surveillance Quality Improvement Project are those that were found to be lacking a K-DOQI-recommended program for stenosis surveillance as determined through the use of CPM data and follow-up.
While the ultimate Network goal is for all facilities to have a stenosis surveillance program, the initiative's aims are:
- to increase the number of targeted facilities with a K-DOQI-recommended program for stenosis surveillance from a measured baseline of 0% to >25% within the span of the project, and
- to increase the percent of patients with AVGs who receive stenosis surveillance in targeted facilities.
Since targeted facilities lack a K-DOQI-recommended stenosis surveillance program, the baseline for this measure is expected to be close to 0%. On the basis of this assumption, the aim will be to increase the measurement at least halfway to the Network average of 58% by project end. This will be accomplished through a multifaceted approach, which will include a communication program, an educational campaign, and focused technical assistance by the Network to improve stenosis surveillance performed in facilities that previously responded “No” or “Unknown” to question 18.1 on the 2008 CPM form.
Tools & Resources
Stenosis Surveillance Data Collection Tool (Excel)
Stenosis Surveillance Data Entry Guide (PDF)
K-DOQI Preferred Graft Surveillance Methods (PDF)
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