title: Patient compliance limits the efforts of quality improvement initiatives on arteriovenous fistula maturation.
abstract: 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 χ(2) 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.
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: Susanna K
authors.initials: SK
authors.lastname: Lynch
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va. Electronic address: ahanchi@yahoo.com.
authors.forename: Sadaf S
authors.initials: SS
authors.lastname: Ahanchi
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: David J
authors.initials: DJ
authors.lastname: Dexter
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: Marc H
authors.initials: MH
authors.lastname: Glickman
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Panneton
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D002404:Catheterization / Q000592:standards; D016009:Chi-Square Distribution; D015897:Comorbidity; D003952:Diagnostic Imaging / Q000379:methods / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010349:Patient Compliance; D011237:Predictive Value of Tests; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D006435:Renal Dialysis / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency