Humana's Your Practice

Arterial Venous Fistulas (AVF):
The Gold Standard for Vascular Access

Recognizing that vascular access is a dialysis patient’s “lifeline,” the Centers for Medicare & Medicaid Services (CMS) and organizations such as the End-Stage Renal Disease (ESRD) Network and National Kidney Foundation have collaborated to promote increased use of native arterial venous fistulas (AVF). Compared to catheters and arterial venous grafts, native AVFs demonstrate significantly lower rates of complications, including infection and clotting. AVFs may also result in longer patency, fewer hospitalizations, lower patient morbidity and mortality and lower costs. The National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (K/DOQI) national practice guidelines, last updated in July 2006, report that more than 65 percent of hemodialysis patients have a functioning AVF.

The National Kidney Foundation recommends early referral of patients diagnosed with chronic kidney disease (CKD) for evaluation and placement of AVFs, when clinically indicated.

Referral to participating network nephrologists is encouraged for all patients with evidence of CKD, but certainly before the glomerular filtration rate (GFR) falls below 30 ml/minute (Stage 4 CKD) for nondiabetics or below 60 ml/minute (Stage 3 CKD) for diabetics. Timely referral allows the nephrologist sufficient time to continue patient education, plan for vascular mapping and refer the patient to a vascular surgeon. Additionally, early referral gives the patient adequate time for a newly created AVF to mature before use.

Many laboratories convert serum creatinine measurements to an estimated GFR. Adding a patient’s gender, age and race to the creatinine request allows for a more precise calculation. If a laboratory does not provide this calculation, primary care physicians or staff members can use an online GFR calculator; one is available at www.kidney.org. Click on “Professionals” and then choose “KDOQI” from the drop-down list. An icon for the calculator is on the right.

For more information about CKD and AVF, visit www.fistulafirst.org or www.renalmd.org. Additionally, K/DOQI chronic kidney disease guidelines can be found on the National Kidney Foundation Web site, www.kidney.org. Click on “Professionals” and then choose “KDOQI” from the drop-down list.

Humana Offers Resources for Caregivers
and Advance Care Planning

Humana’s Medicare Advantage (MA) members can obtain free specialty kits addressing caregiving and advance care planning through Humana Active Outlook^SM, Humana’s lifestyle enrichment program which provides Humana’s Medicare members with active living programs that address the physical, psychological and social aspects of healthy aging. HAO offers both a NurtureCare Caregiver Kit and a LifeKeeper Advance Care Planning Kit.

The NutureCare Caregiver Kit is designed to help caregivers better understand their role in the caregiving process, and the LifeKeeper Advance Care Planning Kit is designed to help members understand their values and wishes and those of their loved ones as they plan for the end of life.

Each Humana MA member is eligible for one free resource kit from each category, and additional kits are available for purchase. Members can visit HumanaActiveOutlook.com or call 1-866-444-7408 for more information. Members with speech or hearing impairments who use a teletypewriter (TTY) can call 1-800-833-3301.

Humana Committed to Quality Improvement

Humana is an industry leader in promoting patient safety and quality care on behalf of its members. In fact, Humana’s mission is to help members make informed decisions based on available information. Humana gathers this information from a variety of sources, including The Leapfrog Group.

Leapfrog’s members are major employers and public agencies that provide health benefits to more than 34 million people in all 50 states. The Leapfrog Group and its members work to improve health care in safety, quality and affordability.

One of the ways the group does this is by publishing data from the Leapfrog Hospital Survey, which uses evidence-based measures and various safety standards to rate the quality of hospitals across the country. Humana encourages all hospitals to respond to the survey at www.leapfroggroup.org.

Since last year, Leapfrog also asks hospitals, via the survey, to commit to its policy on “never events” — events that should never happen in a hospital, such as wrong site surgery or leaving a foreign object inside a patient after surgery. By committing to the policy, hospitals agree to apologize for its mistake, report the mistake to an agency, such as the Joint Commission, perform a root cause analysis and waive all costs directly related to the error. Last year, over half of all responding hospitals indicated their commitment to the policy.