MedicalResearch.com Interview with:
Caitlin W. Hicks, M.D., M.S.
Assistant Professor of Surgery
Recipient of the Department of Surgery
Rothman Early Career Development Award for Surgical Research
Johns Hopkins Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Arteriovenous fistula are associated with better long-term patency, lower rates of infection, and lower long-term costs compared to arteriovenous graft. As a result, the Fistula First Catheter Last Guidelines recommend placement of an arteriovenous fistula over an AVG whenever possible.
We looked at individual physician utilization of AVF vs AVG for first-time AV access in Medicare beneficiaries. We found that the median physician utilization rate for AVG was only 18%, but that 21% of physicians use AVG in more than 34% of cases, which is above currently recommended practice guidelines.
MedicalResearch.com: What should readers take away from your report?
Response: Overall, the utilization of arteriovenous graft has decreased substantially since earlier reports on this topic. However, there is still significant room for improvement.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We envision an individualized feedback intervention whereby outlier physicians would receive notification of their outlier status and educational material on why arteriovenous fistula are preferred for access over AVG. We would like to evaluate whether such an intervention can reduce arteriovenous graft utilization rates even further. Similar interventions have been shown to effectively improve performance in a non-punitive manner in other fields.
Hicks CW, Wang P, Kernodle A, Lum YW, Black JH, Makary MA. Assessment of Use of Arteriovenous Graft vs Arteriovenous Fistula for First-time Permanent Hemodialysis Access. JAMA Surg. Published online June 12, 2019. doi:10.1001/jamasurg.2019.1736
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