Evaluation of Colonoscopy Capacity in New York City Hospitals
New York City Department of Health and Mental Hygiene
Jennifer Leng MD, MPH
Background
Screening colonoscopy can prevent deaths by detecting early disease The NYC Dept of Health and Mental Hygiene (DOHMH) recommends most people 50 years of age and older should undergo colonoscopy every 10 years Screening rates in NYC remain low
Background
In preparation for efforts to improve screening rates, DOHMH will determine current capacity NYC population > 50 years of age: 2 million In order to screen all persons >50 yrs of age every 10 years: need capacity to perform 200,000 per year
Objective
To evaluate the current capacity of New York City hospitals to perform screening colonoscopy exams
Methods
Attempted to contact all 70 NYC acute care hospitals Surveyed staff responsible for scheduling colonoscopy exams Survey conducted Feb 19 – Mar 4, 2003 No patient level information collected
Survey of 70 hospitals: preliminary results
Hospitals completing survey: Hospitals not yet surveyed: Hospitals where no endoscopy performed: 54* 13
3
Percent of endoscopy performing hospitals surveyed 54/67=81% * At 2 hospitals, there are two separate endoscopy clinics, so 56 surveys were completed
Staff surveyed (n=56)
Title n Nurse manager/admin/director 32 Manager/executive admin 6 MD/medical director 5 Coordinator 4 Medical technician/assistant 3 Medical secretary/unit manager 3 Other 3 (%) (57) (11) (9) (7) (5) (5) (5)
Type of endoscopy unit (n=56)
TYPE Inpatient and outpatient Outpatient, hospital based Outpatient, free standing Inpatient only Inpatient, outpatient, and operating room n 35 15 3 2
1
(%) (63) (27) (5) (4)
(2)
Number of physicians available to perform colonoscopy and waiting time for appointment at 56* endoscopy clinics
Number of Physicians: 841 in 56 clinics Range 2-70 Median 10
93% gastroenterologists; 7% surgeons
Waiting time for screening exams (days): Range 0-150 Median 18
*1 site did not provide data on physicians, 3 sites did not provide data on waiting time
Number of colonoscopy exams performed at 56* colonoscopy clinics
Month prior Estimated to survey max/month Lowest Highest Median Total 20 1,200 164 13,006 24 1,200 220 16,582 Number in 2002 400 9,289 2000 154,194
* 1 site did not provide data on "Month prior to survey", 2 sites did not provide data on "Estimated max/month", 1 site did not provide data on "Number in 2002"
Estimated number of exams performed for screening, 2002, 55 clinics
No. of % for clinics (%) screening 11 (20) <25 20 (36) 25-50 22 (39) 50-75 2 (4) >75 Total no. of exams 2002 25,966 62,126 54,852 11,250 No. for screening 3,246 23,297 34,283 9,844
Of the 154,194 colonoscopy exams at the 55 clinics in 2002, an estimated 70,670 were for screening
Estimated unused capacity for screening colonoscopy exams at 55 colonoscopy clinics in NYC
Total colonoscopy exams in 2002: Maximum capacity per year:
16,582, multiplied x 12 months)
154,194 198,984*
– (estimated from reported monthly max capacity of
Assume unused capacity is all available for screening: 198,984 – 154,194 = 44,790
* Based on data from 54 sites
Total estimated capacity for screening at 55 clinics surveyed
Total screening exams 2002: Unused capacity for screening: Maximum annual screening capacity:
71,000 + 45,000
116,000
Annual estimated need: 200,000 Do the 13 hospitals and free-standing clinics not yet surveyed have the additional needed capacity of 84,000?
Barriers preventing endoscopy units from performing more exams (n=56)
_____________________________ No. of clinics (%) Barriers reported: 49 (87) – Inadequate suite time / space 19 (34) – Not enough physicians 16 (29) – Not enough RNs/ technicians 13 (23) – Not enough patients referred 9 (16) – Inadequate reimbursement 7 (13) – No shows/ cancellations 5 (9) – No professional interest 2 (4) – Not enough equipment/ scopes 2 (4) – Other 3 (5) No Barriers 7 (13)
Note: Percents do not add up to 100% as many sites reported >1 barrier
Referrals, reporting, advertising at 56 colonoscopy clinics
Would you like more referrals? - 89% Yes 2% No 9% Unsure Willing to be listed for referrals? - 66% Yes 2% No 32% Unsure Willing to report monthly # of exams? - 59% Yes 2% No 39% Unsure Do you advertise? - 54% Yes 34% No 13% Unsure
Summary
Preliminary data from 54 NYC hospitals - 55 sites performed 154,000 exams in 2002 - Approx. 71,000 for screening - At maximum capacity, 55 sites can perform 116,000 screening exams/yr - Unknown whether 13 hospitals and freestanding clinics not yet surveyed have the capacity to perform needed 84,000 additional screening exams
Conclusions
At 55 surveyed sites, have capacity to perform 45,000 more colonoscopy exams for screening than currently being done Even if we cannot meet need of 200,000/yr, still are not maximizing current capacity Capacity is not a critical obstacle to increasing screening rates
Next steps
Improve current physician and patient awareness to increase screening rates Continue data collection from NYC hospitals Consider extending the survey to include free-standing sites