Main SCVS Site
Final Program
Past & Future Meetings
 

 

Back to Annual Meeting Symposium


Patient Compliance Limits the Efforts of Quality Improvement Initiatives on Arteriovenous Fistula Maturation
Susanna K. Lynch, BS, Sadaf S. Ahanchi, MD, David J. Dexter, MD, Marc H. Glickman, MD, Jean M. Panneton, MD.
Eastern Virginia Medical School, Norfolk, VA, USA.

OBJECTIVES:Our institutional quality improvement (QI) initiative monitors the schedule for arteriovenous fistula (AVF) maturation with follow-up within 30 days after creation, fistulogram within 40 days if indicated, and a second office visit within 8 weeks. Additionally, a patient liaison contacts patients and dialysis units in cases of delayed follow-up. The purpose of this study is to determine the impact of the QI initiative on patient compliance and overall time to AVF maturation.
METHODS: We performed a retrospective review of patients undergoing initial radiocephalic (RC), brachiocephalic (BC), and basilic vein transposition (BVT) creation before the QI initiative (Pre-QI group: January to April 2012) and during the QI period (QI group: January to April 2013). Categorical data was compared using χ2 analysis and nominal data was compared using Student t-test.
RESULTS: We reviewed 198 “first-time” AVF creations in patients with a mean age of 61 years with 57% male. Demographics and comorbidities between the pre-QI and QI groups were similar. During the pre-QI period 110 initial AVFs were created: 28% RC, 44% BC, and 28% BVT, while during the QI period 88 initial AVFs were created: 27% RC, 51% BC and 22% BVT (χ2=0.487). Compliance with the 30-day post-operative appointment increased significantly after the QI initiative, from 48% in the pre-QI group to 65% in the QI group (p=0.015). Yet, the QI initiative did not maintain an impact on the subsequent follow-up checkpoints. No statistical difference was identified for compliance with fistulogram within 40 days of access creation (pre-QI 12% vs. QI 25%, p=0.093) and for compliance with 8-week post-operative appointment (pre-QI 33% vs. QI 23%, p=0.457). Both checkpoints demonstrate a very high non-compliance rate. Accordingly, time to maturation was 88 days for both the pre-QI and QI group, with a failure to mature rate of 22% for the pre-QI group and 21% for the QI group.
CONCLUSIONS:The QI initiative significantly increased the number of patients complying with the first 30-day follow-up appointment after access creation. However, patient compliance with timely fistulogram and second follow-up appointment was very poor and not influenced by the QI initiative, limiting the functional impact of the QI initiative on time to AVF maturation.


Back to Annual Meeting Symposium

 
© 2020 Society for Clinical Vascular Surgery . All Rights Reserved. Privacy Policy.