Research articleColonoscopy Demand and Capacity in New Hampshire
Introduction
Although colorectal cancer (CRC) is a highly preventable disease, it remains the second most common cause of death from cancer in men and women in the United States.1 The 5- to 10-year process by which a benign polyp may become a cancer, combined with the efficacy of polypectomy in interrupting that sequence and preventing cancer, have understandably led to worldwide consensus on the importance of CRC screening. A major preventive health goal is the optimal utilization of screening for this disease.
Despite recognition of the value of CRC screening, less than 40% to 50% of the appropriate U.S. population has undergone any form of screening.1, 2 Based on suitable screening intervals, the availability of capacity to meet demand is unclear; thus, the National Cancer Institute (NCI),3 the Centers for Disease Control and Prevention (CDC),4 and other authors,5 have recently published estimates of endoscopic capacity and demand. Colonoscopy is considered the “gold standard” for screening, and is the method preferred by many primary care providers as well as some organizational guidelines.6, 7, 8 It is also the “final common pathway” for all CRC screening,9 as it is the only test that affords definitive polypectomy; hence, all positive tests lead to, and derive their efficacy from, colonoscopy. Colonoscopy and polypectomy decrease the incidence, as well as the morbidity and mortality, of colon cancer.
The CDC estimates that approximately 14 million colonoscopies were performed in the United States in 2002,4 and the NCI estimates that 4 million were performed in 2000.3 This discrepancy may be due to differences in sampling as well as an actual increase in colonoscopy demand (especially in light of Medicare coverage for screening colonoscopy beginning in 2001); it also highlights the need for the ongoing assessment of demand and capacity. Accurate data are critical in designing screening strategies, which are likely to vary regionally in the United States. Estimates of capacity in smaller geographic areas will improve the accuracy of published national estimates and help guide screening strategies at the local level.10, 11 Therefore, an observational study of screening colonoscopy demand versus capacity in New Hampshire (NH) was conducted.
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Subjects
Using data from the State Department of Health and Human Services and the NH Hospital Association, all centers performing colonoscopy in the state of NH were identified, including hospitals, clinics, and ambulatory centers. Each center was contacted by telephone to verify that they did perform colonoscopy, and to identify the contact person for a telephone interview. Data were collected in 2003 to 2004 and analyzed in 2005 to 2006.
Telephone Interview
A two-phase phone interview was conducted with each center. The
Capacity
There are 36 centers (27 hospitals and nine free-standing ambulatory surgical centers) performing colonoscopy within the state of NH, and in 2002 there were 114 endoscopists doing colonoscopy. Of these, 62 (54.4%) were gastroenterologists; 45 (39.5%) were general or colorectal surgeons; and 3 (2.6%) were family practice or general internal medicine physicians. A specific category was not identified for four other physicians.
The survey results showed that a total 49,352 colonoscopies were
Discussion
Fueled by a growing, worldwide consensus on the efficacy of CRC screening and the increased utilization of screening colonoscopy, recent publications3, 4, 5 have begun to shed light on realistic estimates of screening demand and capacity. Although the demand may not be “endless and limitless”19 as quoted in a recent editorial,9 it does appear to exceed capacity at the present time. To complement the growing body of published estimates of national capacity, results from a smaller sample will
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