It began with a discussion regarding Vascular Access by Dr. Marcia Keen, RN, PhD, CNN, Research Nurse at Ralph K. Davies Medical Center, San Francisco, as well as Amgen and project manager for The DOPPS study.
session touched on the fact that the U.S. is behind most other countries in regards to the goals for the number of fistulas used as a primary access for dialysis patients, especially for patients starting dialysis.
The effect of this has contributed to lower quality outcomes for U.S. patients including a higher mortality rate overall compared to the rest of the world as well as higher hospitalization rates.
There are several aspects to this problem for the U.S. One is that because of the lack of insurance coverage for a large number of pre-ESRD patients many of them are not worked up prior to going on dialysis and consequently a fistula is not placed early.
Another issue is that in comparison to other countries, U.S. vascular surgeons do not have extensive training or experience in fistula creation as is the case in other countries; this factor appears to be associated with high problem rates.
reports were discussed in a workshop format to help attendees understand the data available in QCS to evaluate this issue in their clinics.
Following Dr. Keen's discussion, Diana Hlebovy, RN, BSN, CHN, CNN, Clinical Director of HemaMetrics, and a recognized expert on fluid management, discussed the rationale for emphasizing fluid management in the Conditions for Coverage.