Fistula First Breakthrough Initiative (FFBI)
Fistula First Recognition Program
Improving Your Facility's AVF Rate
Fistula First Breakthrough Initiative
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 50% 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%.
As of April 2008, with 100% of facilities reporting,
Network 5's AV fistula rate was 46%!
We achieved our CMS goal for March 2008--
3 months ahead of schedule!
View a list of facilities with over 40% AV fistulas
SUCCESS STORIES!
Learn how some facilities are increasing their fistula rates.
Fistula First 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. Beginning with first quarter 2008, we will only be recognizing facilities that achieve and maintain an AVF rate of 50% and higher. Guidelines for the 2008 Fistula First Recognition Program follow:
- FANTASTIC FIFTIES Facilities must achieve an AVF rate of 50 to 59.9% (maintained for 3 consecutive months)
- 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:
2nd Quarter 2007
3rd Quarter 2007
4th Quarter 2007
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.
Physicians
Fistula First Project Book
Facility Staff
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.
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)
Surgeons
Creating AV Fistulae in All Eligible Hemodialysis Patients (DVD only)
Additional Resources
National Fistula First Breakthrough Initiative website
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