Patient compliance limits the efforts of quality improvement initiatives on arteriovenous fistula maturation

• Published in: Journal of vascular surgery 2015, Vol.61 (1), p.184-191
• Main Authors: Lynch, Susanna K., BS, Ahanchi, Sadaf S., MD, Dexter, David J., MD, Glickman, Marc H., MD, Panneton, Jean M., MD
• Format: Article
• Language: English
• Subjects: Aged; Arteriovenous Shunt, Surgical; Catheterization - standards; Chi-Square Distribution; Comorbidity; Diagnostic Imaging - methods; Diagnostic Imaging - standards; Female; Health Knowledge, Attitudes, Practice; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Office Visits; Patient Compliance; Predictive Value of Tests; Quality Improvement; Quality Indicators, Health Care; Renal Dialysis - standards; Retrospective Studies; Risk Factors; Surgery; Time Factors; Time-to-Treatment; Treatment Outcome; Upper Extremity - blood supply; Vascular Patency
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2014.05.095

Objective Our institutional quality-improvement (QI) initiative instituted a well-defined office follow-up schedule after arteriovenous fistula (AVF) creation, including an office visit within 30 days, fistulogram within 40 days, if indicated, and a second office visit within 55 days. In addition, a patient liaison contacted patients and dialysis units to improve follow-up. The purpose of this study was to determine the effect of the QI initiative on patient compliance and overall time to AVF permission to cannulate. Methods We performed a retrospective review of patients undergoing first-time radiocephalic, brachiocephalic, and basilic vein transposition creation before the QI initiative (pre-QI group: January to April 2012) and during the QI period (QI group: January to April 2013). Categoric data were compared using χ2 analysis, and nominal data were compared using the Student t -test. Results We reviewed 198 first-time AVF creations in patients (57% male) with a mean age of 61 years. Demographics and comorbidities between the pre-QI and QI groups were similar. Compliance with the first 30-day postoperative appointment increased significantly after the QI initiative, from 48% in the pre-QI group to 65% in the QI group ( P  = .015). Yet, the QI initiative did not maintain an effect 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  = .093) or for compliance with the 55-day postoperative appointment (pre-QI, 33% vs QI, 23%; P  = .457). Both checkpoints demonstrated a very high noncompliance rate. Accordingly, the mean time to permission to cannulate was 88 days for both the pre-QI and QI groups, with a failure to mature rate of 22% for the pre-QI group and 21% for the QI group ( P  = .816). Conclusions The QI initiative significantly increased the number of patients complying with the first 30-day follow-up appointment after AVF access creation. However, patient compliance with a timely fistulogram and the second follow-up appointment was poor and not influenced by the QI initiative, limiting the functional effect of the QI initiative on the time to AVF permission to cannulate.