Optimizing allocation of colorectal cancer screening hospitals in Shanghai: a geospatial analysis

Screening programmes are important for early diagnosis and treatment of colorectal cancer (CRC) but they are not equally effi­cient in all locations. Depending on which hospital people belong to, they often are not willing to follow up even after a positive result, resulting in a lower-than-expected overall detection rate. Improved allocation of health resources would increase the pro­gram’s efficiency and assist hospital accessibility. A target popula­tion exceeding 70,000 people and 18 local hospitals were included in the investigation of an optimization plan based on a location­allocation model. We calculated the hospital service areas and the accessibility for people in communities to CRC-screening hospi­tals using the Huff Model and the Two-Step Floating Catchment Area (2SFCA) approach. We found that only 28.2% of the resi­dents with initially a positive screening result had chosen follow­up with colonoscopy and significant geographical differences in spatial accessibility to healthcare services indeed exist. The lowest accessibility was found in the Southeast, including the Zhangjiang, Jichang and Laogang communities with the best accessibility mainly distributed near the city centre of Lujiazui; the latter also had relatively a high level of what is called “ineffec­tive screening” as it represents wasteful resource allocation. It is recommended that Hudong Hospital should be chosen instead of Punan Hospital as the optimization, which can improve the service population of each hospital and the populations served per colono- scope. Based on our results, changes in hospital configuration in colorectal cancer screening programme are needed to achieve ade­quate population coverage and equitable facility accessibility. Planning of medical services should be based on the spatial distri­bution trends of the population served.