Hicks CW, Wang P, Kernodle A, et al. - Given that the Centers for Medicare & Medicaid has established an arteriovenous fistula (AVF) goal of 66% or greater for initial hemodialysis access in 2009 in order to address the national underuse of AVF in the United States, researchers undertook this claims-based analysis and analyzed more than 85,000 US Medicare patients undergoing first-time permanent hemodialysis access placement in order to gain insight into modern practice patterns and physician features related to high arteriovenous graft use vs AVF use. Findings revealed that the rate of an arteriovenous graft use exceeded the best-practice threshold of 34% in 21% of surgeons. More than 30 years of clinical experience, practice in a metropolitan setting, and a vascular surgery specialty, were identified as surgeon factors that were independently related to high arteriovenous graft use, as noted after accounting for patient features. Patient referral practices could explain some of these variations, it was suggested that more high-value care in hemodialysis access surgery could be achieved by sharing benchmarked performance data with surgeons.