目的  基于“结构-过程-结果”三维质量管理模型，构建并实施动静脉内瘘穿刺护理质量改进方案，系统评价其在多中心血液透析联合体中的应用效果。 方法  采用前瞻性干预性研究设计，于2023年7月─2025年6月在北京大学人民医院血液透析联合体8家成员单位中实施结构化干预措施，以穿刺损伤发生率、疑难血管通路损伤占比、穿刺方法构成作为核心指标，进行阶段性质量监测与持续改进。 结果  研究期间监测总穿刺数为420 999例次，发生穿刺损伤1570例次；穿刺损伤发生率由0.43%降至0.33%(χ2=18.420，P＜0.001)；绳梯法使用比例上升(χ2=42.106，P＜0.001)。护理能级与血管通路分级对应更趋合理。各项改进措施在参与医院中的采纳率为37.5%～100.0%，临床可行性良好。 结论  以专科护理质量指标及关联指标为导向，应用三维质量管理模型实施动静脉内瘘穿刺护理质量持续改进，可有效降低穿刺损伤发生率，提升护理质量，具有较好的推广价值。

Objective To construct and implement a quality improvement program for arteriovenous fistula (AVF) cannulation care based on the "Structure-Process-Outcome" three-dimensional quality management model, and to systematically evaluate its application effectiveness in a multi-center hemodialysis consortium.  Methods A prospective interventional study was adopted. From July 2023 to June 2025, structured intervention measures were implemented across institutions of eight members in the Peking University People's Hospital Hemodialysis Alliance, carrying out phased monitoring and continuous improvement and focusing on the core indicators of   cannulation injury rate, proportion of injuries related to difficult vascular access, and composition of cannulation methods.  Results  During the study period, a total of 420 999 cannulation manipulations were monitored, with 1,570 cannulation injuries recorded. The incidence of cannulation injury decreased significantly from 0.43% to 0.33% (P＜0.001). The utilization rate of the rope-ladder technique increased significantly (P＜0.001). The alignment between nursing competency level and vascular access grading became more rational. The adoption rate of the improvement measures ranged from 37.5% to 100.0% among participating hospitals, demonstrating better clinical practicability.  Conclusion  Based on the professional nursing quality indicators and related controls, the quality of AVF cannulation care can be continuously improved by the three-dimensional quality management model. This model reduces cannulation injury rate to enhance overall nursing quality, and is valuable to be widely promoted.