Evaluation of Colonoscopy Capacity in New York City Hospitals

1. Evaluation of Colonoscopy Capacity in New York City Hospitals New York City Department of Health and Mental Hygiene Jennifer Leng MD, MPH Good morning, my name is Jennifer Leng from the Dept of health, today I will be discussing the evaluation of colonoscopy capacity in NYC hospitals. Good morning, my name is Jennifer Leng from the Dept of health, today I will be discussing the evaluation of colonoscopy capacity in NYC hospitals.

2. 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 � Colonoscopy can prevent deaths by detecting early, localized disease when treatment is most likely to be successful, or by removal of pre-cancerous polyps Persons at high risk for colorectal cancer should begin screening at age 40 or earlier. DOHMH recommends colonoscopy as the preferred screening test � From Medicaid data Jan-June 2002, 3.4 out of 100 Medicaid recipients (over age 45) had a colonoscopy (annualized rate). If all enrollees (over age 45) were to have a colonoscopy every 10 years, should expect to see 10 out of 100 who had a colonoscopy. Lorna will discuss this later, just say �data on screening rates will be presented later in the day�� Colonoscopy can prevent deaths by detecting early, localized disease when treatment is most likely to be successful, or by removal of pre-cancerous polyps Persons at high risk for colorectal cancer should begin screening at age 40 or earlier. DOHMH recommends colonoscopy as the preferred screening test � From Medicaid data Jan-June 2002, 3.4 out of 100 Medicaid recipients (over age 45) had a colonoscopy (annualized rate). If all enrollees (over age 45) were to have a colonoscopy every 10 years, should expect to see 10 out of 100 who had a colonoscopy. Lorna will discuss this later, just say �data on screening rates will be presented later in the day�

3. 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 � According to Census 2000, there are 2 million persons over age 50 living in New York City. If each person has a colonoscopy every 10 years, approximately 200,000 colonoscopies would be performed per year. � If colonoscopy capacity is found to be insufficient, resources can be targeted towards increasing the number of colonoscopies that can be performed. In the event that capacity is found to be adequate, prevention efforts can be directed towards increasing awareness amongst the public, physicians, and community/advocacy groups to increase screening rates � According to Census 2000, there are 2 million persons over age 50 living in New York City. If each person has a colonoscopy every 10 years, approximately 200,000 colonoscopies would be performed per year. � If colonoscopy capacity is found to be insufficient, resources can be targeted towards increasing the number of colonoscopies that can be performed. In the event that capacity is found to be adequate, prevention efforts can be directed towards increasing awareness amongst the public, physicians, and community/advocacy groups to increase screening rates

4. Objective To evaluate the current capacity of New York City hospitals to perform screening colonoscopy exams

5. 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 By telephone. Main hospital number called, asked to be transferred to endoscopy suite. Also asked �is this clinic the only site within this facility or affiliated with this facility that performs colonoscopy exams?� If there were affiliated sites (that weren�t already listed as separate hospitals) they were called and also surveyed.By telephone. Main hospital number called, asked to be transferred to endoscopy suite. Also asked �is this clinic the only site within this facility or affiliated with this facility that performs colonoscopy exams?� If there were affiliated sites (that weren�t already listed as separate hospitals) they were called and also surveyed.

6. Survey of 70 hospitals: preliminary results Hospitals completing survey: 54* Hospitals not yet surveyed: 13 Hospitals where no endoscopy performed: 3 Percent of endoscopy performing hospitals surveyed 54/67=81% * At 2 hospitals, there are two separate endoscopy clinics, so 56 surveys were completed 3 sites no endoscopy done, endoscopy done at affiliated site: for st. luke�s roosevelt, all scopes done at roosevelt site; for bronx leb fulton, scopes done at concourse site, for St. Vincent�s Catholic med center, done at West 11th st. site 2 of the surveyed hospitals had an affiliated site that also performed colonoscopy, so a total of 56 surveys were completed. 2 affiliates, 1 was Lenox Hill Community Medical Center, part of Lenox Hill and Surgicenter part of BI- King�s highway3 sites no endoscopy done, endoscopy done at affiliated site: for st. luke�s roosevelt, all scopes done at roosevelt site; for bronx leb fulton, scopes done at concourse site, for St. Vincent�s Catholic med center, done at West 11th st. site 2 of the surveyed hospitals had an affiliated site that also performed colonoscopy, so a total of 56 surveys were completed. 2 affiliates, 1 was Lenox Hill Community Medical Center, part of Lenox Hill and Surgicenter part of BI- King�s highway

7. Staff surveyed (n=56) Title n (%) Nurse manager/admin/director 32 (57) Manager/executive admin 6 (11) MD/medical director 5 (9) Coordinator 4 (7) Medical technician/assistant 3 (5) Medical secretary/unit manager 3 (5) Other 3 (5) � Other includes 1 GI fellow, 1 OR supervisor, 1 OR systems and data coordinator� Other includes 1 GI fellow, 1 OR supervisor, 1 OR systems and data coordinator

8. Type of endoscopy unit (n=56) TYPE n (%) Inpatient and outpatient 35 (63) Outpatient, hospital based 15 (27) Outpatient, free standing 3 (5) Inpatient only 2 (4) Inpatient, outpatient, and operating room 1 (2) � inpt/outpt suites obviously hospital based 10 of these sites are public hospitals (5 inpt/outpt, 3 outpt hosp based, 2 outpt free standing) rest are private hospitals� inpt/outpt suites obviously hospital based 10 of these sites are public hospitals (5 inpt/outpt, 3 outpt hosp based, 2 outpt free standing) rest are private hospitals

9. 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 Asked �How many different physicians perform colonoscopy procedures at this facility?� so this is range of number of physicians performing scopes at each facility Other = 5% colorectal surgeons and 2% general surgeons Waiting period to schedule pt for a routine screening colonoscopy Mostly conscious sedation. 52 sites used conscious sedation for some proportion of their cases, mean proportion of cases using conscious sedation 93%, median 99%. Remainder of cases done at these 52 sites with anesthesia supported sedation or no sedation. 3 sites 100% anesthesia supported, 1 don�t know 44 (79%) of sites : 0-20% of procedures done with endoscopist meeting patient for first time on day of procedure Asked �How many different physicians perform colonoscopy procedures at this facility?� so this is range of number of physicians performing scopes at each facility Other = 5% colorectal surgeons and 2% general surgeons Waiting period to schedule pt for a routine screening colonoscopy Mostly conscious sedation. 52 sites used conscious sedation for some proportion of their cases, mean proportion of cases using conscious sedation 93%, median 99%. Remainder of cases done at these 52 sites with anesthesia supported sedation or no sedation. 3 sites 100% anesthesia supported, 1 don�t know 44 (79%) of sites : 0-20% of procedures done with endoscopist meeting patient for first time on day of procedure

10. Number of colonoscopy exams performed at 56* colonoscopy clinics � this is number of exams actually performed during month prior to survey, how many COULD be performed, and how many actually were performed in 2002 � this is number of exams actually performed during month prior to survey, how many COULD be performed, and how many actually were performed in 2002

11. Estimated number of exams performed for screening, 2002, 55 clinics