• Health Policy and Government Relations
• Contact Congress - Take Legislative Action
• SVS Health Policy Committee Meets with Senators/Staff
• Priority Issues
• Imaging Cuts
• SAAAVE Act
• Physician Payment
• Pay For Performance (P4P)
• Fistula First Initiative
• Malpractice Reform
• Reimbursement
• Regulatory Issues
• Political Action Committee
• 110th Congress Committee Assignments

Home > Medical Professionals > Health Policy and Government Relations > Fistula First Initiative > SVS Endorses Fistula First

SVS Endorses "Fistula First"  

On June 30, SVS endorsed the Centers for Medicare & Medicaid Services (CMS) - National Vascular Access Improvement Initiative, also known as Fistula First.

The initiative was launched in April 2004 to improve vascular access for hemodialysis patients, specifically to help ensure that patients receive arterial venous (AV) fistulas where indicated and feasible. CMS, the ESRD Networks, the Institute for Healthcare Improvement and the renal community are collaborating on this initiative.

Most vascular access-related morbidity and mortality and costs are associated with the use of grafts and catheters. Recent trends show a decrease in access patency, an increase in morbidity/mortality and an increase in the cost of care for dialysis patients that may be largely attributable to the low prevalence of functional AV fistulas for maintenance hemodialysis. More than 20 percent of hemodialysis patient days are related to vascular access dysfunction; however, patients with AV fistulas have a significantly lower risk of hospitalization and surgery than patients with AV grafts.
 
Fistula First has developed a 'change package' comprising 11 changes in practice across the ESRD treatment continuum that have shown results in practice and are supported by the medical literature.

The ESRD Networks are now working with providers to implement these recommendations, which include the following:

-	Routine CQI review of vascular access
-	Timely referral by primary care physician to nephrologist
-	Early referral to surgeon for ?AV fistula only? evaluation and timely placement
-	Surgeon selection based on best outcomes, willingness, and ability to provide access services
-	Utilization of full range of appropriate surgical procedures to AV fistula evaluation and placement
-	Secondary AV fistula placement in patients with AV grafts
-	AV fistula placement in patients with catheters where indicated
-	Cannulation training for AV fistulas
-	Monitoring and maintenance to ensure adequate access function
-	Outcomes feedback to guide practice

By its endorsement of Fistula First, SVS encourages its members to support and participate in the Fistula First projects.

For more information, visit the Fistula First website, which resides on the Institute for Healthcare Improvement site: http://www.ihi.org/IHI/Topics/ESRD/ VascularAccess. Click on the link, ?Where should I begin if I am a surgeon?? That link describes specific actions surgeons can take to begin to increase AV fistula use in dialysis patients.