Open access phone triage for veterans with suspected malignant pleural mesothelioma

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• 作者：Charles Jeff Siegert ; MD^a ; ^b ; Piero Marco Fisichella ; MD ; MBA ; FACS^b ; Jennifer M. Moseley ; MSN ; FNP-BC^a ; ^b ; Melina Shoni ; MD^a ; ^c ; Abraham Lebenthal ; MD ; MHA^a ; ^c ; ^d ; ^{alebenthal@partners.org}
• 关键词：Asbestos ; Centralized care model ; Evidence-based treatment ; Guidelines based practice ; Malignant pleural mesothelioma ; Phone triage ; Single-payer system ; Veterans ; Veterans Administration Healthcare System
• 刊名：Journal of Surgical Research
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：207
• 期：Complete
• 页码：108-114
• 全文大小：1026 K
• 卷排序：207

文摘

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.MethodsA 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.ResultsSixty 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.ConclusionsOur 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.