2003 - 2006: FistulaFirst, the National Vascular Access Improvement Initiative (NVAII)

All Networks are currently involved with FistulaFirst, the National Vascular Access Improvement Initiative (NVAII).

The Centers for Medicare & Medicaid Services (CMS) has announced an important new initiative called "FistulaFirst," aimed at significantly increasing the use of AV fistulas (AVF) for hemodialysis access. The initiative will engage nephrologists, vascular surgeons, dialysis facilities, primary care physicians, and patients in changing practice to assure that AVFs are the first choice for every eligible patient.

Goals : The FistulaFirst project aims to fulfill the goals recommended by the National Kidney Foundation's Dialysis Outcomes Quality Initiative: AVF rates of 50% or greater for incident patients, and at least 40% for prevalent patients undergoing hemodialysis. This constitutes a significant increase over current national averages, which are 29% for incident patients and 31% for prevalent patients.

In addition to CMS, project partners include: the 18 ESRD Networks, dialysis providers across the country, nephrologists, vascular access surgeons, interventional radiologists, and interventional nephrologists. The Institute for Healthcare Improvement (IHI) and Clinical Chair Lawrence Spergel, MD, have assisted in developing a package of 11 "change concepts" and are supporting the ESRD Networks as they develop and implement strategies for spreading the recommended changes.

For further information, contact your ESRD Network. A complete listing of ESRD Networks can be found at: http://www.esrdnetworks.org/.

[FistulaFirst is an initiative of the Centers for Medicare & Medicaid Services and the Department of Health and Human Services. Project assistance provided by the Institute for Healthcare Improvement: http://www.qualityhealthcare.org/IHI/Topics/ESRD/