For the past 4 years, the VA Boston Healthcare System (VABHS) has implemented a consulting service to veterans diagnosed with mesothelioma. Through a process called phone triaging, patients were assessed over the phone and given evidence-based treatment recommendations. This practice was deemed beneficial and changed the therapeutic outcome for many patients.
Each year, 2,500 people are diagnosed with mesothelioma. 1 out of 3 people are a veteran. This is due to the widespread use of asbestos in every branch of the military. Naval vessels, aircraft carriers, and barracks are just a few examples of where asbestos was found.
Improving Access to Care
The Veteran’s Healthcare Administration (VHA) had one main goal in mind when deciding to start phone consults: to improve access to care within the system.
Even though the VHA is the largest integrated healthcare system in the United States, only two out of more than 1,700 facilities have a mesothelioma specialist, Boston and Los Angeles. Many other VA doctors do not have experience with this type of cancer or do not offer extensive thoracic procedures, like the extra pleural pneumonectomy and intraoperative heated chemotherapy.
Patients who want to see one of the two mesothelioma specialists may need to travel long distances to get a consultation. Boston’s mesothelioma specialist, Dr. Abraham Lebenthal, saw a need to improve the way veterans access care within the VHA. This prompted his team to create the mesothelioma phone triage program.
Dr. Lebenthal and his team at the VA Boston Healthcare System came up with three methods to measure their plan of implementing phone consults:
- Ability to perform long distance phone triage
- Assess speed of access to a mesothelioma specialist in the VA health system
- Determine if access to a specialist would alter the plan of care
The Mesothelioma Phone Triage Program is a Success
Over 4 years, 60 male veterans with mesothelioma were evaluated by phone consult through the VABHS. ⅓ of the veterans were from the New England area and 38 veterans traveled from all across the country, as far as Alaska. A few patients were told they were not surgical consults and did not travel, but received recommended care locally. It took an average of 10-14 days from the initial phone consult to be seen in Boston.
Surgery offers veterans the best chance of long-term survival. Veterans no longer have to accept a 6-12 month prognosis. The VABHS concluded that they could perform phone consults in a timely manner and change the outcome of treatment for most veterans. In a federal system, they were able to deliver expert care that is usually only possible in top teaching hospitals.
How the Phone Triage Program Works
Patients using the phone triage program contacted a general thoracic surgeon at the VABHS.
1The initial phone interview lasted about an hour, making sure the patient was a US veteran enrolled in VA health benefits with the possible diagnosis of malignant pleural mesothelioma. Patients needed to grant access to their veteran’s electronic medical records if they were out of the New England network.
2Once the information was compiled and reviewed, the team contacted the patient with their initial treatment recommendations. This also included whether or not they felt the patient should travel to the VABHS. Travel and housing was facilitated by the patient’s regional VA facility along with an administrative assistant from the VABHS. Once the patient arrived, housing was provided free of charge.
3Many times, VABHS would perform 2-3 days of additional testing before the patient would meet with the mesothelioma specialist. This was performed to confirm diagnosis of malignant pleural mesothelioma, histology, and staging. The patient’s wishes were taken into account.
4After all of this data was reviewed at the VABHS thoracic tumor board, a treatment plan was delivered to the veteran.
If you are a veteran diagnosed with malignant pleural mesothelioma, do not hesitate to contact me so I can get you enrolled in the mesothelioma phone triage program.
You can call our nurse directly at 888-385-2024 x 102 or contact by email firstname.lastname@example.org.
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