Does a vascular access surveillance program reduce access-related costs and complications?
Ralf Schindler
Nature Clinical Practice Nephrology (2007) 3, 254-255
Background
Vascular access complications impose a considerable burden on health care budgets, facilities and staff.
Objective
To ascertain the effect of a 'quality improvement program', based on regular vascular access flow monitoring, on access-related costs and complications.
Design and intervention
University Hospital Maastricht, The Netherlands, was the setting for this retrospective study. Access-related complications, interventions, costs and outcomes among incident hemodialysis patients with an arteriovenous fistula or graft were compared between the periods 2001–2003 (the 'quality improvement period') and 1996–1998 (the 'reference period'). All eligible patients were included. During both periods, occluded accesses were directed to surgical thrombectomy. During the reference period, vascular access surveillance comprised palpation before cannulation, auscultation before dialysis, and measurement of blood pressure during treatment. Abnormal findings prompted angiography (and percutaneous transluminal angioplasty [PTA] if stenosis was present). During the quality improvement period, flow was measured every month in grafts and every 3 months in fistulas, using the Transonic® HD01 device (Transonic Systems Inc., Ithaca, NY). Detection of low flow or a considerable drop in flow prompted angiography and PTA. Access-related costs during both periods were calculated from December 2002 cost data.
Outcome measures
The end points were rates of intervention (e.g. angiography, PTA and surgical thrombectomy), thrombotic occlusion and access loss, and access-related costs (e.g. of monitoring, intervention and hospitalization).
Results
Total follow-up was 214.4 patient-years for the reference period (n = 119) and 218.6 patient-years for the quality improvement period (n = 117). Compared with the reference period, the quality improvement period was associated with lower rates, per patient-year, of angiography (0.28 vs 0.53; P = 0.047) and thrombectomy (0.25 vs 0.63; P <0.0005), and a higher rate per patient-year of combined angiography and PTA (0.88 vs 0.33; P <0.0005). When the study population was divided into subgroups on the basis of type of vascular access, rates of thrombotic occlusion per patient-year were lower during the quality improvement period than during the reference period for both the fistula subgroup (0.09 vs 0.21; P = 0.022) and the graft subgroup (0.45 vs 1.14; P <0.0005). Seventeen accesses were lost during each period. Total access-related costs per patient-year during the quality improvement period were 33% lower than during the reference period in the whole population (1,538.40 vs 2,289.16; P = NS), and 41% lower among the patients with grafts (2,360.95 vs 4,003.96; P = 0.01).
Conclusion
A vascular access monitoring program seems to reduce the frequencies of thrombotic access occlusion and surgical intervention, and decreases access-related costs in patients with arteriovenous grafts, but does not alter access survival.
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Does a vascular access surveillance program reduce access-related costs and complications?
血管通路监控程序能够降低通路相关的并发症及花费
Ralf Schindler
Nature Clinical Practice Nephrology (2007) 3, 254-255
Background背景
Vascular access complications impose a considerable burden on health care budgets, facilities and staff.血管通路并发症给卫生保健中的设备和人员的预算增加了很大负担。
Objective目的
To ascertain the effect of a 'quality improvement program', based on regular vascular access flow monitoring, on access-related costs and complications.根据有规律的血管通路流量监测对通路相关的花费和并发症的影响，明确诊断改善程序的作用。
Design and intervention设计和介入
University Hospital Maastricht, The Netherlands, was the setting for this retrospective study. 我们在荷兰的马斯垂克大学医院进行这项回顾性研究。
Access-related complications, interventions, costs and outcomes among incident hemodialysis patients with an arteriovenous fistula or graft were compared between the periods 2001–2003 (the 'quality improvement period') and 1996–1998 (the 'reference period'). All eligible patients were included.对1996-1998（参考期）和2001-2003（诊断改善期）的通路相关的并发症、介入和血液透析或者移植导致的动静脉瘘的费用和结果进行比较，包括全部具有适应症患者。
During both periods, occluded accesses were directed to surgical thrombectomy. 在这两个期间，通路闭塞的患者全部进行外科血栓切除术。
During the reference period, vascular access surveillance comprised palpation before cannulation, auscultation before dialysis, and measurement of blood pressure during treatment. Abnormal findings prompted angiography (and percutaneous transluminal angioplasty [PTA] if stenosis was present).在参考期，血管通路监护包括套管插入术前的触诊、透析前的听诊和治疗期的血压测量。发现异常进行血管造影（如果有峡窄进行经皮经管腔血管成形术）
During the quality improvement period, flow was measured every month in grafts and every 3 months in fistulas, using the Transonic® HD01 device (Transonic Systems Inc., Ithaca, NY). Detection of low flow or a considerable drop in flow prompted angiography and PTA.在诊断改善期，用Transonic® HD01对移植的患者进行每个月一次的血液流动进行测量，对动静脉瘘的患者进行三个月一次的血液流动进行测量。检测发现低流速或者流速降低迅速的患者进行血管造影和经皮穿刺血管成形术。
Access-related costs during both periods were calculated from December 2002 cost data.这两个时期血管通路相关的花费根据2002年的价格计算。
Outcome measures结果措施
The end points were rates of intervention (e.g. angiography, PTA and surgical thrombectomy), thrombotic occlusion and access loss, and access-related costs (e.g. of monitoring, intervention and hospitalization).结果通过评估介入（血管造影、经皮经管腔血管成形术和外科血栓切除术）、血栓闭塞、通路丧失和通路相关的花费（包括监测、介入和住院的费用）
Results结果
Total follow-up was 214.4 patient-years for the reference period (n = 119) and 218.6 patient-years for the quality improvement period (n = 117). 在整个随访的参考时间(n = 119)214.4 patient-years，在诊断改善期有218.6 patient-years(n = 117)。
Compared with the reference period, the quality improvement period was associated with lower rates, per patient-year, of angiography (0.28 vs 0.53; P = 0.047) and thrombectomy (0.25 vs 0.63; P <0.0005), and a higher rate per patient-year of combined angiography and PTA (0.88 vs 0.33; P <0.0005).比较参考期，在每病例年的诊断改善期具有低的血管造影率(0.28 vs 0.53; P = 0.047)、血栓切除术(0.25 vs 0.63; P <0.0005)和较高的血管造影术和经皮穿刺血管成形术的联合应用(0.88 vs 0.33; P <0.0005)。
When the study population was divided into subgroups on the basis of type of vascular access, rates of thrombotic occlusion per patient-year were lower during the quality improvement period than during the reference period for both the fistula subgroup (0.09 vs 0.21; P = 0.022) and the graft subgroup (0.45 vs 1.14; P <0.0005). 当我们根据血管通路的类型对研究人群进行分类，瘘管患者(0.09 vs 0.21; P = 0.022)和移植患者(0.45 vs 1.14; P <0.0005)在每病例年诊断改善期血栓形成率均比对照期低。
Seventeen accesses were lost during each period.每个期都有17个血管通路失败。
Total access-related costs per patient-year during the quality improvement period were 33% lower than during the reference period in the whole population (1,538.40 vs 2,289.16; P = NS), and 41% lower among the patients with grafts (2,360.95 vs 4,003.96; P = 0.01).每病例年通路相关的总费用在诊断改善期总体上比对照起低33%(1,538.40 vs 2,289.16; P = NS)，移植患者低22%(2,360.95 vs 4,003.96; P = 0.01)。
Conclusion结论
A vascular access monitoring program seems to reduce the frequencies of thrombotic access occlusion and surgical intervention, and decreases access-related costs in patients with arteriovenous grafts, but does not alter access survival.血管通路监测程序可以减少血栓通路闭塞和外科手术的频率，降低动静脉移植的费用，但是不能改变通路存活率。
血管通路监控程序能够降低通路相关的并发症及花费
作者Ralf Schindler
patient-year 理解其中含义，但不知道是否有固定翻译！
文中有不妥之处，请专业人士批评指正，谢谢！
'quality improvement program'译为质量改善程序更好。
请按照文摘编译格式进行编译，谢谢
背景：血管通路并发症给卫生保健中的设备和人员的预算增加了很大负担。
目的：根据有规律的血管通路流量监测对通路相关的花费和并发症的影响，明确诊断改善程序的作用。
设计和介入
我们在荷兰的马斯垂克大学医院进行这项回顾性研究。对1996-1998（参考期）和2001-2003（诊断改善期）的通路相关的并发症、介入和血液透析或者移植导致的动静脉瘘的费用和结果进行比较，包括全部具有适应症患者。在这两个期间，通路闭塞的患者全部进行外科血栓切除术。在参考期，血管通路监护包括套管插入术前的触诊、透析前的听诊和治疗期的血压测量。发现异常进行血管造影（如果有峡窄进行经皮经管腔血管成形术）在诊断改善期，用Transonic® HD01对移植的患者进行每个月一次的血液流动进行测量，对动静脉瘘的患者进行三个月一次的血液流动进行测量。检测发现低流速或者流速降低迅速的患者进行血管造影和经皮穿刺血管成形术。这两个时期血管通路相关的花费根据2002年的价格计算。
结果措施：结果通过评估介入（血管造影、经皮经管腔血管成形术和外科血栓切除术）、血栓闭塞、通路丧失和通路相关的花费（包括监测、介入和住院的费用）
结果：在整个随访的参考时间(n = 119)214.4 patient-years，在诊断改善期有218.6 patient-years(n = 117)。比较参考期，在每病例年的诊断改善期具有低的血管造影率(0.28 vs 0.53; P = 0.047)、血栓切除术(0.25 vs 0.63; P <0.0005)和较高的血管造影术和经皮穿刺血管成形术的联合应用(0.88 vs 0.33; P <0.0005)。当我们根据血管通路的类型对研究人群进行分类，瘘管患者(0.09 vs 0.21; P = 0.022)和移植患者(0.45 vs 1.14; P <0.0005)在每病例年诊断改善期血栓形成率均比对照期低。每个期都有17个血管通路失败。每病例年通路相关的总费用在诊断改善期总体上比对照起低33%(1,538.40 vs 2,289.16; P = NS)，移植患者低22%(2,360.95 vs 4,003.96; P = 0.01)。结论：血管通路监测程序可以减少血栓通路闭塞和外科手术的频率，降低动静脉移植的费用，但是不能改变通路存活率。
