title: Impact of a quality improvement programme based on vascular access flow monitoring on costs, access occlusion and access failure.
abstract: BACKGROUND
  Vascular access thrombosis is a substantial source of morbidity in chronic haemodialysis patients. Periodical access flow measurements can predict the presence of vascular access stenosis and provide an opportunity for early intervention to prevent subsequent vascular access thrombosis. By this system of quality improvement, vascular access-related costs might be reduced. The aim of this study was to analyse the cost impact of a quality improvement programme based on periodic access flow measurements.
  
  
  METHODS
  The number and costs of vascular access interventions (summary of angiography, percutaneous transluminal angioplasty, catheter placement, hospitalization days and costs for surgery) in the period 2001-2003 (quality improvement period; QIP, 218.6 patient-years observed) were retrospectively compared with a reference period (RP, 1996-1998, 214.4 patient-years observed) during which no access flow was measured. All access flow measurements were done on a regular base and interventions were performed according to the Kidney Disease Outcome Quality Initiative.
  
  
  RESULTS
  Surgical thrombectomy procedures were significantly less during the QIP (0.25 +/- 0.57 events/patient-year) compared with RP (0.63 +/- 1.06 events/patient-year; P = 0.000), whereas access loss was not significantly different. During the QIP, 205 radiological interventions were performed (0.88 +/- 1.16 events/patient-year), and in the RP around 48 (0.33 +/- 0.65 events/patient-year; P = 0.000). Access-related costs tended to be lower during the QIP compared with the RP. The cost reduction appeared to be limited to patients with arteriovenous graft (AVG), in which access-related costs were significantly lower during the QIP (2360.95 euro +/- 2838.17 euro patient-year) compared with the RP (4003.96 euro +/- 3810.92 euro patient-year; P = 0.012), but not in patients with arteriovenous fistula (AVF).
  
  
  CONCLUSIONS
  A quality improvement programme based on periodical access flow measurement reduced the number of acute vascular access failures due to thrombotic events and also significantly reduced health care costs in patients with AVG, but not in patients with AVF. The quality improvement programme had no effect on access survival.
authors.affiliation: Department of Internal Medicine and Nephrology, University Hospital Maastricht, P. Debyelaan 25, 6202AZ Maastricht, Maastricht, The Netherlands.
authors.forename: Edwin
authors.initials: E
authors.lastname: Wijnen
authors.forename: Nils
authors.initials: N
authors.lastname: Planken
authors.forename: Xavier
authors.initials: X
authors.lastname: Keuter
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Tordoir
authors.forename: Michiel W
authors.initials: MW
authors.lastname: de Haan
authors.forename: Karel M L
authors.initials: KM
authors.lastname: Leunissen
authors.forename: Frank
authors.initials: F
authors.lastname: van der Sande
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011786:Quality Control; D006435:Renal Dialysis / Q000191:economics* / Q000379:methods / Q000592:standards*; D013927:Thrombosis / Q000191:economics* / Q000209:etiology* / Q000517:prevention & control