Territorial equity assessment within a colorectal cancer screening program: Usefulness of colonoscopy quality indicators.

Abstract

Objective: The primary goal of a public health system is to ensure universal access to high-quality medical care. However, disparities in health outcomes have been observed across socio-demographic groups, some of them potentially related to their geographical location. To assess territorial equity, the Catalan Colorectal Cancer Screening Program was used, focusing on the adenoma detection rate (ADR) endoscopists.

Patients and methods: This population-based screening program is based on fecal immunochemical testing. Positive individuals undergo colonoscopy in the endoscopy unit corresponding to their area of residence. Both ADR and serrated polyp detection rate (SPDR) of all endoscopists were assessed and reported in terms of variability among endoscopy units and proportion of endoscopists who did not reach pre-established quality standards (40% and 20%, respectively).

Results: A total of 35,825 colonoscopies performed by 206 endoscopists of 39 endoscopy units were evaluated. Analysis of ADR variability revealed that 11 units (28.2%) performed significantly above the average of Catalonia, while 3 units (7.7%) performed below it. In terms of SPDR variability, 22 units (56.4%) significantly exceeded the average, whereas 8 units (20.5%) fell below this benchmark. Moreover, all endoscopists in 28 units (71.8%) achieved the ADR threshold of 40%, while this was the case in only 12 (30.8%) when using the SPDR threshold of 20%.

Conclusion: Quality of colonoscopy, measured by the ADR, was high with minimal variability among units; however, using the SPDR revealed greater variability. This analysis underscores the value of indicators derived from screening programs as essential tools for evaluating potential territorial inequities.