title: Health resource utilization and multidisciplinary impact of endoscopic ultrasonography in a tertiary referral medical center.
abstract: BACKGROUND
  Endoscopic ultrasound (EUS) is a resource-intensive endoscopic procedure, but may result in high downstream health resource utilization and multispecialty impact. Our aim was to examine the downstream impact of EUS by specialty and by indication.
  
  
  METHODS
  A retrospective chart review was performed at an academic medical center for patients for whom EUS represented the first point of contact at the study institution within a 20-month period.
  
  
  RESULTS
  A total of 552 EUS procedures were reviewed and 208 represented the first point of contact. The most common principle indication involved the pancreas (n = 117, 56%). Downstream health utilization was calculated for an average of 313 days postprocedure (range: 35-632 days). Following unique referral for endoscopic ultrasound, 52% of the patients in the study were retained within the institution for further management and, of these, 34% had a major intervention in the form of surgery or chemoradiotherapy. Compared with other indications, patients presenting with a pancreatic mass were significantly more likely to remain in the study institution for further management (62% versus 39%, p = 0.005), were more likely to have a downstream surgery (29% versus 14%, p = 0.020) and were more likely to have downstream chemo-radiotherapy (11% versus 3%, p = 0.012).
  
  
  CONCLUSIONS
  EUS represents a unique portal of entry into tertiary referral medical centers. First point of contact EUS referrals are associated with major downstream health resource utilization and significantly increased utilization for mass lesions of the pancreas.
authors: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors: Jamie B
authors: JB
authors: Sodikoff
authors: Sagar S
authors: SS
authors: Garud
authors: Steven A
authors: SA
authors: Keilin
authors: Sheila J
authors: SJ
authors: Bharmal
authors: Melinda M
authors: MM
authors: Lewis
authors: Qiang
authors: Q
authors: Cai
authors: Field F
authors: FF
authors: Willingham
keywords: endoscopic ultrasound; fine-needle aspiration; health utilization; pancreatic mass
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