Quality Improvement Project
Improving Access Stenosis Management
(2002-2003)
ESRD Network 18
ABSTRACT
As a result of an arteriovenous (AV) graft monitoring rate of only
32% (CMS, 2001), ESRD Network 18 undertook a quality improvement project focusing
on establishing a formal vascular access surveillance (VAS) in a group of
intervention facilities with a large percentage (>55%) of AV grafts. A second group of facilities with a VAS program already in place served
as basis of comparison. Study indicators included presence of a VAS
program, stenosis evaluation and treatment referral rates, thrombosis rates,
and missed dialysis treatment rates. Results
varied by individual facility throughout the project, but the trends for the
intervention group indicated a greater improvement in evaluation and treatment
rates and fewer thrombolytic events and missed treatment days. In the intervention group, 81% of the facilities started a VAS program
by the end of the project, and the percentage of all hemodialysis facilities
Network-wide increased from 46% to 75%. Process
indicators that contributed to success of a VAS program included presence
and support of policies & procedures, and easy documentation forms. Lack of simple documentation forms, cost factors,
and no HMO reimbursement were major barriers for beginning a VAS program identified
by facilities.
