Research article
Colonoscopy Demand and Capacity in New Hampshire

https://doi.org/10.1016/j.amepre.2006.08.026Get rights and content

Background

Screening for colorectal cancer has been clearly shown to decrease the incidence and mortality from this disease. Accurate information about the demand and capacity for screening, particularly with colonoscopy, is critical in planning screening strategies. National assessments have recently begun; estimates of smaller geographic regions should improve the accuracy of national estimates, as well as inform strategies for individual states. This study evaluates the demand and capacity for colonoscopy in the state of New Hampshire.

Methods

All endoscopy sites in the state of New Hampshire were contacted to determine their number of endoscopists, monthly colonoscopies, and estimates of the percentage of colonoscopy done for screening. Barriers to increasing current capacity were also assessed. The capacity estimates were compared to demand estimates based on population census figures. Data were collected in 2003 to 2004 and analyzed in 2005 to 2006.

Results

One hundred fourteen endoscopists at 36 centers performed 49,352 colonoscopies in 2002, an average of 39 to 43 total monthly colonoscopies per endoscopist. Approximately 60% were estimated to have been done for screening. Estimated demand was approximately twice the available capacity for screening and surveillance. The impact of factors such as compliance, percent screening, and population growth were assessed to inform future screening strategies.

Conclusions

In 2002, demand for screening colonoscopy in New Hampshire for patients aged more than 50 years was approximately twice the available capacity. However, if the assessed screening capacity of 2002 were to increase by 20%, combined with a target of 60% population compliance with screening as an initial goal, the demand for colonoscopy in New Hampshire would be met.

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.

Section snippets

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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