Open access phone triage for veterans with suspected malignant pleural mesothelioma

J Surg Res. 2017 Jan;207:108-114. doi: 10.1016/j.jss.2016.08.031. Epub 2016 Aug 19.

Abstract

Background: Phone triaging patients with suspected malignant pleural mesothelioma (MPM) within the Veterans Healthcare Administration (VHA) system offers a model for rapid, expert guided evaluation for patients with rare and treatable diseases within a national integrated healthcare system. To assess feasibility of national open access telephone triage using evidence-based treatment recommendations for patients with MPM, measure timelines of the triage and referral process and record the impact on "intent to treat" for patients using our service.

Methods: A retrospective study. The main outcome measures were: (1) ability to perform long distance phone triage, (2) to assess the speed of access to a mesothelioma surgical specialist for patients throughout the entire VHA, and (3) to determine if access to a specialist would alter the plan of care.

Results: Sixty veterans were screened by our phone triage program, 38 traveled an average of 997 miles to VA Boston Healthcare system. On average, 14 d elapsed from initial phone contact until the patient was physically evaluated in our general thoracic clinic in Boston. The treatment plan was altered for 71% of patients evaluated at VA Boston Healthcare system based on 2012 International Mesothelioma Interest Group guidelines.

Conclusions: Our initial experience demonstrates that in-network centralized care for Veterans with MPM is feasible within the VHA. National open access phone triage improves access to expert surgical advice and can be delivered in a timely manner for Veterans using our service. Guideline-based treatment recommendations ("intent to treat") changed the therapeutic course for the majority of patients who used our service.

Keywords: Asbestos; Centralized care model; Evidence-based treatment; Guidelines based practice; Malignant pleural mesothelioma; Phone triage; Single-payer system; Veterans; Veterans Administration Healthcare System.

MeSH terms

  • Aged
  • Boston
  • Feasibility Studies
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Male
  • Mesothelioma / diagnosis*
  • Pleural Neoplasms / diagnosis*
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Telemedicine / methods*
  • Telemedicine / statistics & numerical data
  • Telephone
  • Triage / methods*
  • Triage / statistics & numerical data
  • United States
  • United States Department of Veterans Affairs
  • Veterans Health*