Purpose: To develop a model to determine colonoscopy and sigmoidoscopy capacity needs for a 6-year period beginning in January 2005, with particular attention paid to quality and access goals.

Method: Kaiser Permanente Northern California adopted improvement of colorectal cancer screening rates as a priority in 2005. To quantify the additional resources required to improve access to colonoscopy and sigmoidoscopy, we developed a model estimating the demand associated with a target rate of colorectal cancer screening of 70%. This demand was used to estimate the number of MD and procedural assistant full time equivalents (FTEs), procedure rooms and recovery beds needed each year from 2005-2010. The model is based on expert assumptions regarding productivity and the proportion of the population requiring or choosing colonoscopy.

The tool is designed to apply at the regional level and at the medical center level, based on population projections specific to each area. An important feature is that several assumptions in the model can be varied in real time by end users. This enables local quantification of the impact of variance in productivity from the regional norm or changes in demand patterns--e.g., increased preference for colonoscopy. Coupled with ongoing monitoring of productivity, positivity rates, and patient choice, the tool can be used to quickly update projections for ongoing planning. Another feature that could be added to the model is the inclusion of FOBT screening and it's effect on the demand for colonoscopy.

Results: For a health system of 3.2 million people, including 884,000 people over the age of 50, we estimate that improving colorectal cancer screening rates will require an investment of 10 MD FTE's and 26 non-MD FTEs for colonoscopy, 11 MD/RNP FTEs and 16 non-MD FTEs for sigmoidoscopy, 41 recovery beds, and 15 procedure rooms, in the first year of the program. These projections were used to determine the amount of funding to be made available to improve capacity to meet screening goals. The model is also being used by the Endoscopy Department chiefs to support the development of plans to effectively apply this funding.

Conclusion: Providing a specific but flexible tool to quantify demand and capacity for colorectal cancer screening provides a rational approach to resource allocation to support access and quality improvement.