title: Open access phone triage for veterans with suspected malignant pleural mesothelioma.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: VA Boston Healthcare System, Section of General Thoracic Surgery, West Roxbury, Massachusetts; VA Boston Healthcare System, Department of Surgery, West Roxbury, Massachusetts.
authors.forename: Charles Jeff
authors.initials: CJ
authors.lastname: Siegert
authors.affiliation: VA Boston Healthcare System, Department of Surgery, West Roxbury, Massachusetts.
authors.forename: Piero Marco
authors.initials: PM
authors.lastname: Fisichella
authors.affiliation: VA Boston Healthcare System, Section of General Thoracic Surgery, West Roxbury, Massachusetts; VA Boston Healthcare System, Department of Surgery, West Roxbury, Massachusetts.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Moseley
authors.affiliation: VA Boston Healthcare System, Section of General Thoracic Surgery, West Roxbury, Massachusetts; Division of General Thoracic Surgery, Brigham And Women's Hospital, Boston, Massachusetts.
authors.forename: Melina
authors.initials: M
authors.lastname: Shoni
authors.affiliation: VA Boston Healthcare System, Section of General Thoracic Surgery, West Roxbury, Massachusetts; Division of General Thoracic Surgery, Brigham And Women's Hospital, Boston, Massachusetts; International Mesothelioma Program, Brigham And Women's Hospital, Boston, Massachusetts. Electronic address: alebenthal@partners.org.
authors.forename: Abraham
authors.initials: A
authors.lastname: Lebenthal
mesh_terms: D000368:Aged; D001900:Boston; D005240:Feasibility Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis*; D010997:Pleural Neoplasms / Q000175:diagnosis*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods* / Q000706:statistics & numerical data; D013689:Telephone; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health
keywords: Asbestos; Centralized care model; Evidence-based treatment; Guidelines based practice; Malignant pleural mesothelioma; Phone triage; Single-payer system; Veterans; Veterans Administration Healthcare System