Since someone posted a ranking of top programs here is an article from Medical Economics that came out Jan 23, 2009
http://www.modernmedicine.com/moder...atology/ArticleStandard/Article/detail/576055
If you don't have acces I'll cut and past the whole article below:
Quality medical care can be found in every specialty and in every corner of the country, in hospitals and free clinics, in solo practices, and in sprawling medical centers. Sometimes, though, a clinical center, through a combination of talent, hard work, resources, funding, and leadership, rises above the pack in certain areas.
While some centers are known throughout the medical community for their overall expertise, we saw a need for a physician's guide to the best in various specialties.In response to this, Medical Economics is proud to launch the first of what will be a regular series: Clinical Centers of Excellence. The purpose is to recognize those hospitals that bring a little something extra to a specialty, whether through research, patient care, or community outreach.
We've chosen the centers based on information from key opinion leaders in various specialties and through physician surveys. To help choose the Clinical Centers of Excellence in Dermatology, we surveyed readers of Dermatology Times and spoke with dermatology KOLs. We then asked the centers to report data and other information, which was verified whenever possible.
Geography is a factor as well. Doctors are more likely to recommend—and patients are more likely to visit—a center that is nearby rather than one across the country.The institutions profiled in this issue—the Mayo Clinic, University of Michigan Health System, Wake Forest University Baptist Medical Center, and University of California, San Francisco Medical Center—have dermatology programs that are among the finest in the country.
Though we could not profile them all, we have included a list of other Centers of Excellence identified by our surveys and key opinion leaders. We do not rank any of the centers relative to each other, but explain what makes them unique.
Clinical Centers of Excellence for Dermatology
Harvard Medical School, Cambridge, Massachusetts
The Mayo Clinic, Rochester, Minnesota
University of California, San Francisco Medical Center, San Francisco, California
Mount Sinai Medical Center, New York, New York
New York University Medical Center, New York, New York
University of Texas Health Sciences Center at Houston, Houston, Texas
University of Michigan Health System, Ann Arbor, Michigan
Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
Advanstar Clinical Centers of Excellence
Institutions under consideration to be named Clinical Centers of Excellence are asked to self-report data, which is checked against publicly available information. Depending on the specialty, these criteria may include:
Quality-improvement initiatives under way
Community outreach
National awards and recognition
Participation in national therapeutic initiatives (e.g., the National Cancer Consortium, Children's Oncology Group, etc.)
Number of referrals for the particular specialty area
Number of international referrals
Number of patients treated/procedures performed per year
Number of research protocols engaged in annually
Number of medication/surgical errors
Systems in place to prevent errors
Outcomes data (e.g., mortality/morbidity rates, unnecessary readmission rates, etc.)
Level of technological equipment on site
EHR processes and level of development
Participation in regional systems integration initiatives
Follow-up care programs (e.g., enforcement of secondary prevention/medication compliance)
Patient education efforts
Patient satisfaction survey results
Infectious disease prevention efforts
Availability of comprehensive care programs (e.g., preventive cardiology)
Evidence of incorporating research and clinical care
High ranking by NCQA
KOL publishing records
Medical Nobel Laureates on faculty
JCAHO certification/accreditation
Mayo Clinic
Rochester, Minnesota
A dedicated inpatient service, an outpatient service seeing 60,000 patients per year, the 13,000 procedures performed annually, and the more than 430,000 laboratory and dermatopathology tests addressed each year provides ample support for the clinical and population-based research the Mayo Clinic dermatology department is known for.
While most of the patients entering dermatology inpatient treatment are referred for serious or recalcitrant skin diseases, the overwhelming number of referrals are to the Mayo Clinic's dermatopathology laboratory, says Randall K. Roenigk, MD, chair, department of dermatology.
Of the more than 430,000 blood and tissue samples processed in 2008, 70 to 80 percent of those requiring immunohistologic processing were sent in from outside the Mayo Clinic area. "I would estimate that for routine pathology 70 to 80 percent of specimens are from the Rochester area and only 30 percent come from other institutions. But for immunopathology, the ratio is reversed," Roenigk says.
In fact, the immunopathology department has grown substantially during the past few years to accommodate the referrals. "We have a large volume of specimens that are sent in relating to gastrointestinal disease because we developed some of the tests for GI disorders that have skin implications," Roenigk explains. For example, the antigliadin antibody test for celiac disease, which has both GI and dermatologic manifestations, is commonly ordered by dermatologists and GI specialists.
Enhancing Primary Care
The large volume of dermatology outpatient visits combined with the 3,000 Moh's procedures and 10,000 non-biopsy procedures for other skin cancer treatments, wide-excisions, grafts, flaps, and wound repairs has prompted Mayo Clinic dermatologists to actively engage and educate primary care practices. This helps primary care physicians diagnose and treat the more common dermatologic conditions that account for 70 percent of cases such as warts, dermatitis, psoriasis, eczema, and skin cancer. "If we took care of all of these people in our department it would make it difficult for more complicated patients to access care," Roenigk says.
The dermatology department has therefore initiated a program for wart treatment where primary care patients have warts evaluated and treated by a dermatologic nurse. Follow-up care is through their primary care physicians.
Mayo Clinic dermatologists also help primary care practices with skin cancer diagnoses. "Primary care physicians are pretty good at identifying skin cancer," says Roenigk. "We can train them how to do a biopsy and when there is a biopsy there is a pathology specimen. If you have a basal cell and have seen your family practitioner there is no reason for a separate dermatology consult before surgery."
The dermatology department is currently planning other ways to help primary care physicians bring more dermatology care into their practices, Roenigk says.
Clinical Care
In addition to a dedicated dermatology inpatient treatment program and the diverse dermatologic surgery program, the Mayo Clinic offers an intensive 3-week inpatient psoriasis treatment program and maintains a phototherapy treatment center.
The psoriasis programs emphasize patient education about the disease as well as the importance of follow-up care, says Marian T. McEvoy, vice chair of the dermatology department. "Within that 3-week period there are stress management classes and when released patients will have an ongoing plan for how they will manage their disease," she says. Since many of these patients are referrals, some will follow up with outside community dermatologists.
Clinical care is also provided by dermatologists specializing in research and treatment of atopic dermatitis, cutaneous lymphoma, connective tissue disease, transplant, bullous disease, and contact/occupational dermatitis. Some of the more difficult conditions treated include lupus erythematosus, nephrogenic fibrosing dermopathy, pyoderma gangrenosum, scleroderma, calciphylaxis, dermatomyositis, erythema multiforme, porphyrias, and vascular abnormalities.
Academics and Research
Dermatology academics and research are structured to be intertwined with patient care at the Mayo Clinic. "We have a comprehensive academic program that has been highly successful over a long period of time," says Roenigk, who is also chair of the dermatology residency program. Established in 1916, the Mayo Clinic Rochester has 25 residents and seven fellowship slots annually. "We are probably the largest academic clinical practice in the country at a single site center," says Roenigk "This brings a large educational aspect to our practice."
We also engage our residents and fellows in research because our education program requires a research or scholarly component," he adds. "Our residents are not only learning from the clinical practice, our faculty is full-time in the department, they are not just sitting as faculty part-time. Faculty are with the residents all the time."
While electronic health records are a recent development, the dermatology department has long been able to use the Mayo Clinic's meticulously-kept records to foster retrospective disease state and population-based studies. "If a research idea develops in our practice we are able to go back and look at patient records," explains Roenigk. A large research staff also helps to put prospective study protocols in place that use data gathered from the ongoing high-volume procedural and office dermatology practice.
As a result of these efforts, Mayo Clinic dermatologists consistently publish 52 to 65 unique research papers annually in peer-reviewed journals.
The Mayo Clinic also has an active Melanoma Study Group that is currently engaged in nine basic science and clinical trials. The research includes a blood and tissue repository for evaluating potential inheritable factors in families with melanoma and pancreatic cancer and a study to evaluate outcomes of radiation therapy following surgery for desmoplastic melanoma. Metastatic melanoma clinical trials include a phase 1 study of a poly (ADR-ribose) polymerase inhibitor, a phase 2 trial of an intravenous acylsulfonamide, and a phase 3 trial of intralesional allovectin-7.
Researchers are also evaluating a heat-shock vaccine and peptide vaccines combined with other agents for melanoma treatment as well as an investigational antibody plasma therapy.
University of California, San Francisco Medical Centers
San Francisco, California
An in-depth look into the many endeavors of the dermatology departments of the University of California, San Francisco Medical Centers reveals that clinical care is anchored by an underlying foundation of research and education. "We are basically the last resort for complex dermatology problems in the region," says Bruce Wintroub, MD, professor and chair, dermatology departments. "The clinical program is of high quality in every area that we operate in."
The UCSF Medical Centers, include the affiliated San Francisco General Hospital and VA Medical Center, and are strong in general dermatology, dermatologic surgery, including the 1,500 skin cancer procedures performed annually, cutaneous oncology, and dermatopathology.
The dermatology hospitalist program typifies how successful integration of education and research can emerge through quality clinical care. The first of its kind in the country, UCSF employs two dedicated dermatology hospitalists. A typical patient may be the 65-year-old man with chronic obstructive pulmonary disease referred by his primary care physician for admission due to a severe psoriasis flare upon systemic steroid withdrawal.
There are more dramatic cases, says Lindy P. Fox, director, hospital consultation service, and assistant professor of clinical dermatology. She describes a patient with 40 percent of his upper thigh and leg eaten away by what was misdiagnosed as cellulitis with thrombocytosis after elective surgery. Fox was consulted just before the patient was to have interventional surgery in an attempt to debride the wound. "It was classic pyoderma gangrenosum that feeds on trauma," she says. Additional surgery would have worsened the condition.
While UCSF dermatology hospitalists treat many challenging conditions, they also specialize in treating graft vs. host disease, soft tissue infections, fungal infections, and fever with rash.
UCSF is developing a program to expand the dermatology hospitalist service outside the UCSF Medical Centers, says Timothy G. Berger, MD, director of clinics and executive vice chair, department of dermatology, and associate director of the dermatology residency program.
Pediatric dermatology
"Our pediatric dermatology program is a resource for the entire San Francisco Bay area and the West Coast, especially for vascular malformations in children, and has pioneered the understanding of therapy in that area," says Wintroub.
The Birthmarks and Vascular Anomalies Center was founded in 1991 and its seven-member staff is led by pediatric dermatologist and Director Ilona Frieden, MD. While patients are referred for more common capillary malformations such as port wine stains and salmon patches, the majority of referrals are for more debilitating and potentially life-threatening vascular tumors and malformations.
In addition to hemangiomas, the staff treats a variety of venous, lymphatic, arteriovenous, and mixed malformations including lymphangioma, cavernous hemangioma, glomangioma, Klippel-Trenaunay-Weber syndrome,and Proteus syndrome. Because many of these are chronic malformative diseases rather than curable vascular anomalies, treatment focuses on alleviating the most debilitating aspects of the disease.
Through the pediatric fellowship program, UCSF has seeded and propagated other vascular anomaly treatment programs that are now available in many dermatology centers, Berger says.
UCSF operates several outpatient skin care centers and according to Wintroub, has the largest phototherapy center on the West Coast. "We take patients with very serious skin disease who would have been hospitalized 20 years ago as outpatients." The skin care centers and phototherapy center treat 10 to 12 patients daily with aggressive topical treatment, systemic care, and phototherapy for their sometimes intractable psoriasis and eczema. The most difficult psoriasis cases are often incorporated into UCSF research protocols.
Conjunctive Programs
The UCSF dermatology community outreach efforts and its dermatopathology department are notable complements to the institution's clinical care programs.
The three full-time and two part-time dermatopathologists review about 80,000 tissue specimens each year and, of these, about 10,000 are previously prepared slides making diagnosis more challenging. "This is a very high-powered service," notes Wintroub. The department's special research interests include the molecular cytogenetics of melanoma, cutaneous lymphoma, vascular neoplasms, and inflammatory skin disease.
While 90 percent of the tissue specimens examined are referred from California and throughout the United States, the department does receive international requests. The department accepts glass slides, immunofluorescence samples, wet tissue specimens, and frozen tissue specimens.
Members of the UCSF dermatology department have long been active in community melanoma education and outreach. In 2007 the department built a playground shade structure and offered free skin cancer screenings, but in 2008 developed a more pointed approach. "We decided to have a community-based skin cancer screening in each of the ethnic neighborhoods to specifically tailor screening to the issues that address that community," explains Berger.
In 2008 the community-based screening program began with the gay community and focused on risk factors specific to the community such as increased sun exposure. In 2009 the UCSF skin cancer screening will target the Chinese-American community. "It will address their issues -- thinking they can't get skin cancer when, in fact, they can," Berger says. The screening programs are conducted in association with the American Academy of Dermatology and the local health department.
Research and Education
Successful research programs ultimately lead to better patient care and the UCSF dermatology department has consistently ranked among the top five in terms of National Institutes of Health research funding for the past decade, says Wintroub. In 2007 the department received 20 research grants totaling $2.6 million and in 2004 it received $3.5 million.
Areas of research encompass basic, clinical, and translational science as well as clinical investigation and UCSF research protocols are often carried out in conjunction with the affiliated VA Medical Center and San Francisco General Hospital. Current research focuses on the following:
Cutaneous oncology
Skin disease genetics
Virology pathogenesis
Translational epidemiology
Biology of permeability and skin barrier function
Photosensitivity
Carcinogenesis
Melanoma
Drug resistance
Immunology
Environmental and occupational contact dermatitis
Health policy science
HIV/AIDS-associated dermatologic disease
Hair and nail disorders
In addition, research within the dermatopathology department includes clinicopathologic studies and immunoperoxidase, ultrastructural, and molecular biologic investigation of the aspects of skin disease.
"Our educational program is marked by being among the most competitive dermatology residency programs in the country," Wintroub says. Post-residency fellowships are offered in pediatric dermatology, Moh's surgery, and diagnostic dermatopathology including ancillary diagnostic training in immunoperoxidase techniques and molecular biology.
Several research fellowships are offered annually and current areas of focus are clinical hair research, HIV dermatology, psoriasis, melanoma, and cutaneous oncology.
Strongly agree!
