Impact of surgeon and surgical center characteristics on choice of permanent vascular access

摘要: Impact of surgeon and surgical center characteristics on choice permanent vascular access. Background The impact the autogenous arteriovenous (AV) fistula versus artificial AV graft as access for hemodialysis has not been studied. Methods We used national data from Department Veterans Affairs Health Administration to measure association with initial among patients undergoing their first placement procedure between October 1, 2000 September 30, 2001 (fiscal year 2001). Data were analyzed using a hierarchical logistic regression model clustered surgeon. Results study population included 1114 patients, 74 Medical Centers, 182 surgeons. Seventy-two percent received an form After adjusting differences in patient, center, characteristics, odds at high volume centers (>30 procedures per year) more than three times greater low [odds ratio (OR) 3.26, 95% confidence interval (95% CI) 1.37 7.75, P = 0.008]. In addition, strong clustering effect was present level (OR 1.55, CI 1.19 2.03, 0.001) but indicating practice pattern. Conclusion Barriers can exist levels respectively. Future strategies improve rates should target surgeons addition nephrologists, primary care providers.