No other Greater Boston facility recognized
BOSTON –Tufts Medical Center announced today that DCI Boston, which operates the Tufts MC outpatient dialysis program, has been recognized by the End-Stage Renal Disease Network of New England as one of only seven dialysis facilities, out of 170 in New England to use arteriovenous (AV) fistulas to perform dialysis on more than 70% of its hemodialysis patients. The arteriovenous fistula, constructed from the patient’s own artery and vein, is the best form of access to the circulation for hemodialysis, resulting in better health outcomes and lower health care costs. No other facility in Greater Boston was among the centers recognized.
Located on the Tufts Medical Center campus, DCI Boston is staffed and managed entirely by Tufts MC clinicians. Dialysis Clinic Inc., a non-profit operator of dialysis clinics, is based in Nashville and operates 209 facilities in 27 states. It is affiliated with many academic medical centers, and is a nationally-recognized leader in quality and efficiency.
For individuals with kidney failure, dialysis is a means of kidney replacement therapy that mimics kidney functions. Hemodialysis is the most common form of dialysis—used in approximately 90 percent of US patients—and depends on access to the blood through catheters in the veins or grafts or fistulas connecting the veins and arteries. Research published in the American Journal of Kidney Diseases, edited by Dr. Andrew Levey, Chief of Nephrology at Tufts Medical Center, has consistently shown that within a year of beginning dialysis, catheter patients face a mortality rate of 30 to 75 percent higher than those treated through a fistula. Despite these figures, only a slight majority of the 350,000 dialysis patients in the US are treated through fistulas.
Use of arteriovenous fistulas for hemodialysis is a nationally accepted marker for high quality care. The Centers for Medicare and Medicaid Services established a national goal that arteriovenous fistulas should be used for 66 percent of dialysis patients by 2009, a goal met at the DCI Boston clinic at Tufts Medical Center. However, as of August 2010, the national rate of fistula use was only 56 percent, while the New England rate was 60.3 percent. At the DCI Boston clinic at Tufts Medical Center, 75.5 percent of patients receive dialysis through fistulas.
“This is quite an achievement for us,” explains Daniel Weiner, MD, Associate Medical Director of DCI Boston, a nephrologist at Tufts Medical Center. “There has been a lot of effort on the part of a lot of people to make this happen.”
Weiner explained that one major reason fistulas are not used as extensively as they should be is that they require dedication by a team of surgeons, radiologists, nephrologists, nurses and technicians to properly install and maintain. Catheters, on the other hand, can be inserted in only about 30 minutes by a radiologist or surgeon.
The collaborative team at Tufts Medical Center and DCI Boston has been able to increase fistula rates by actively suggesting the treatment to appropriate patients, meeting weekly to discuss patients with difficult venous/arterial access, and aggressively monitoring and examining patients with fistulas to make sure they remain usable.
“This recognition represents significant interdisciplinary accomplishment consistent with tremendous efforts on the part of Transplant Surgery, Interventional Radiology and Nephrology here at Tufts,” states Weiner. The medical director of the dialysis program, Klemens Meyer, MD, along with surgeons Jeffrey Cooper, MD and Richard Rohrer, MD, and radiologists Kevin Daly, MD, Neil Halin, DO, FSCVIR, and E. Kent Yucel, MD, have all played a critical role in the achievement.
In addition to better health outcomes, the use of fistulas as opposed to grafts and catheters results in lower health care costs. Weiner explains that this boils down to far fewer hospitalizations in patients with fistulas versus those with catheters or grafts.
About Tufts Medical Center and Floating Hospital for Children
Tufts Medical Center is an exceptional, not-for-profit, 415-bed academic medical center that is home to both a full-service hospital for adults and Floating Hospital for Children. Conveniently located in downtown Boston, the Medical Center is the principal teaching hospital for Tufts University School of Medicine. Floating Hospital for Children is the full-service children's hospital of Tufts Medical Center and the principal pediatric teaching hospital of Tufts University School of Medicine. Tufts Medical Center is affiliated with the New England Quality Care Alliance, a network of more than 1,800 physicians throughout Eastern Massachusetts. For more information, please visit www.tuftsmedicalcenter.org.