Department of Medicine

Transcription

1 Research Education Patient Care 2012/2013 Department of Medicine A n n u a l P r o g r e s s R e p o r t

2 The commitment to exceptional patient care begins with revolutionary discovery. University Hospitals Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine, a national leader in medical research and education and consistently ranked among the top research medical schools in the country by U.S.News & World Report. Through their faculty appointments at Case Western Reserve University School of Medicine, physicians at UH Case Medical Center are advancing medical care through innovative research and discovery that bring the latest treatment options to patients. All National Institutes of Health (NIH) funding for basic and clinical research is awarded to the School of Medicine at Case Western Reserve University. Table of Contents 1 Chairman s Message 3 Cardiovascular Medicine 4 Clinical and Molecular Endocrinology 5 Gastroenterology and Liver Disease 6 General Internal Medicine and Geriatrics 7 Hematology and Oncology 8 Infectious Diseases and HIV Medicine 9 Nephrology and Hypertension 10 Pulmonary, Critical Care and Sleep Medicine 11 Rheumatology 12 Veterans Affairs 13 Educational Programs 14 Research 15 University Hospitals Harrington Discovery Institute 16 Departmental Administration 17 Faculty and Budget Trends 18 Research Funding 19 Education and Clinical Service 20 Significant Accomplishments 2012/ U.S.News & World Report Rankings medicine.case.edu

3 Richard A. Walsh, md Chairman Department of Medicine Chairman s Message Welcome to the Annual Report of the Department of Medicine for the academic year 2012/2013. Case Western Reserve University School of Medicine faculty, staff and trainees had an outstanding year by any measure. A sampling of honors and awards for our faculty includes: Mukesh Jain, MD, became President of the American Society of Clinical Investigation; Albert Waldo, MD, received the University Hospitals Distinguished Physician Award; Debra Leizman, MD, received the Ohio Chapter of the American College of Physician s Master Teacher Award; Keith Armitage, MD, became Chairelect of the Organization of Program Director s Associations of the Council of Medical Specialty Societies; Neal Meropol, MD, became a board member of the American Society of Clinical Oncology; and Stanton Gerson, MD, received the Case Western Reserve Medal of Excellence in Health Science Innovation. Finally, I was deeply honored to receive the Robert H. Williams, MD, Distinguished Chair of Medicine Award from the Association of Professors of Medicine. We experienced another fine result in the U.S.News & World Report rankings, six of our subspecialties advanced. Our clinical programs continue to advance in volume and in their quality. We experienced another fine result in the U.S.News & World Report rankings. Six of our subspecialties advanced: 13th in digestive disorders and gastroenterology, 15th in cancer, 19th in cardiology and heart surgery, 21st in geriatrics, 22nd in nephrology, 26th in diabetes and endocrinology, and pulmonology remains 38th in the nation. Direct research expenditures on federal awards remained constant, despite the negative adjustment in the NIH salary cap and the impact of the legislatively imposed reduction in the NIH budget produced by sequestration. The Harrington Project for Discovery & Development, under the direction of Jonathan Stamler, MD, continues to flourish. The Harrington Discovery Institute at University Hospitals Case Medical Center continued on next page 1

4 Chairman s Message continued Our educational programs remain enormously robust and are strongly supported by our faculty. awarded nearly $1 million in grants to 10 outstanding physician-scientists selected from a national competition. An Innovation Support Center comprised of highly experienced drug development professionals was created to provide mentorship and assistance in commercialization. The BioMotiv for-profit development arm of the project was launched to advance a portfolio of the most promising programs through human proof-of-concept studies. Our educational programs remain enormously robust and are strongly supported by our faculty. The 2013 residency match was highly successful with a substantial increase in total applicants and an outstanding incoming class. Our teaching sites at University Hospitals Case Medical Center and the Louis Stokes Cleveland VA Medical Center were by a wide margin the top choice for Case Western Reserve University School of Medicine students to complete their internal medicine acting internships. Our full-time faculty provides approximately 30 percent of the total teaching time in the School of Medicine. Medical student and resident participation in national meetings was at an all-time high in 2012/2013. Please become more familiar with our department by examining this report and visiting our website at medicine.case.edu. It is an honor and a pleasure to lead our outstanding faculty, staff and trainees. Sincerely, Richard A. Walsh, md Chairman Department of Medicine 2

5 Daniel Simon, md Division Chief Cardiovascular Medicine Cardiovascular Medicine It was another banner year for the Division of Cardiovascular Medicine in our continuous pursuit of excellence in cardiovascular care. Our most substantial accomplishment of the year was UH Harrington Heart & Vascular Institute receiving national recognition as a premier cardiology and heart surgery program, ranked 19th nationally by U.S.News & World Report. UH Harrington Heart & Vascular Institute s clinical performance continued to grow with a 10.3 percent increase in inpatient discharges and an 8.1 percent increase in outpatient activities in 2012 compared to University Hospitals Ahuja Medical Center contributed significantly to the increase in overall volume, with inpatient discharges growing 77 percent and outpatient activities increasing 109 percent. In addition, the Valve and Structural Heart Disease Center experienced an increase of over 350 patients presenting with severe aortic stenosis for open heart surgery (conventional therapy) or TAVR (minimally invasive transcatheter aortic valve replacement). University Hospitals Case Medical Center is one of only 40 clinical sites in the nation with both the Medtronic CoreValve and Edwards Sapien TAVR programs. Marco Costa, MD, is further advancing our health care services by leading a pivotal U.S. trial of the left ventricular (LV) parachute device for LV restoration therapy for patients with advanced heart failure after heart attack. This year UH Harrington Heart & Vascular Center received the highest quality performance on The Joint Commission quality scorecard for heart attack and heart failure care with 100 percent of heart attack patients treated at UH Case Medical Center exceeding the within 90 minutes guideline for door-to-balloon time. This outstanding performance led to a featured article in The Wall Street Journal. Our most substantial accomplishment of the year was UH Harrington Heart & Vascular Institute receiving national recognition as a premier cardiology and heart surgery program, ranked 19th nationally by U.S.News & World Report. The division s research activities remain strong with the Case Cardiovascular Research Institute, under the direction of Mukesh Jain, MD, totaling 22 grants (17 R01, two K-grants, one T32 grant and two American Heart Association National Scientist Development grants). The research support of the division in 2012 amounted to $15.7 million (NIH: $7.9M and Industry: $7.8M). Our total committed NIH funding as of 2012 is $30 million. UH Harrington Heart & Vascular Institute Research & Innovation Center, under the direction of Dr. Costa, achieved its highest total of 87 clinical trials with more than 1,500 patients enrolled and an estimated total budget of more than $4 million. With the help of the Medtronic Foundation that awarded a $1.4 million grant to Case Western Reserve University to collaborate with Makerere University School of Medicine and Mulago Hospital in Kampala, Uganda, we were able to further expand the international reputation and reach of our faculty. We are currently initiating and developing new clinical and research programs in cardiovascular disease in Uganda. Finally, the continued dedication of our faculty to exemplary health care resulted in an array of prestigious awards and honors this year. Mukesh Jain, MD, and Daniel Simon, MD, were elected members of the Association of American Physicians as well as Association of University Cardiologists. Dr. Jain was appointed President-elect of the prestigious American Society for Clinical Investigation and Councilor of the North American Vascular Biology Organization. Albert Waldo, MD, received the American College of Cardiology Lifetime Achievement Award for his contributions to cardiovascular medicine. 3

6 Clinical and Molecular Endocrinology Baha Arafah, md Division Chief Clinical and Molecular Endocrinology Our educational and training program emphasizes the importance of understanding basic physiological mechanisms along with deep and thorough appreciation of a patient s individuality. The primary mission of the Division of Endocrinology is to continue to achieve excellence in providing outstanding patient care, advancing the field through basic and translational research and educating the next generation of leaders in our specialty. The Division of Endocrinology has a long history of academic achievements and productivity in several disciplines within the specialty. The division s internationally renowned investigators have made important scientific contributions in basic and clinical research projects involving diabetes mellitus and thyroid illnesses as well as diseases of the pituitary and adrenal glands. Faculty members within the division have had a leading role in planning and conducting several recent NIH-sponsored national clinical trials addressing diabetes management and its complications. These include ACCORD, BARI-2 and EDIC studies. The division s contributions to research have culminated in several high-impact articles published recently by our faculty in prestigious journals that set the standards of care for patients with diabetes. The studies have made a major impact on the future management of the disease and led to newer NIH-sponsored clinical trials that have just initiated, for example, GRADE study. Our faculty members provide clinical expertise in all disciplines of the specialty. The division prides itself for having a highly dedicated and strongly motivated team of physicians, scientists, researchers, trainees, nurses and nurse practitioners working synchronously together to achieve our mission and educate a new generation of endocrinologists. Our educational and training program emphasizes the importance of understanding basic physiological mechanisms along with deep and thorough appreciation of a patient s individuality. The training program focuses on independent learning, inquiry, debate and critical appraisal of literature. Our trainees are given ample opportunities to be involved in clinical, translational or bench research. They proceed to have successful careers in academic institutions as well as in clinical practice. All faculty members are engaged in teaching and various research activities. The division has been recognized nationally and internationally for many years for its academic contributions and has been on the U.S.News & World Report list of Best Hospitals for several consecutive years. 4

7 Fabio Cominelli, md, phd Division Chief Gastroenterology and Liver Disease Gastroenterology and Liver Disease Welcome to the Division of Gastroenterology and Liver Disease. With over 40 members, our nationally ranked group of gastroenterologists, hepatologists, PhDs, and nurse practitioners together create the medical anchor of University Hospitals Digestive Health Institute. During the past year, we listened to our community and have broadened our geographic reach, making specialized care more accessible across Northeast Ohio. With a new presence at UH Twinsburg Health Center, and expanded services at UH Ahuja Medical Center, UH Chagrin Highlands Health Center and UH Westlake Health Center, top-ranked subspecialists provide access to patients closer to home. Our clinical programs continue their successes that produced the highest U.S.News & World Report adult subspecialty ranking within the health system (nationally ranked 13th). Our Dworken Inpatient Unit at UH Case Medical Center opened in July 2011 and has transformed the way we care for inpatients with digestive diseases. In a 12-month-study conducted on the unit, the average length of stay for a patient was reduced by one day. The reduction in time spent in the hospital not only decreases resource utilization, eliminating unnecessary costs, but also increases patient satisfaction by getting patients healthy and home in a safe and efficient manner. With a new presence at UH Twinsburg Health Center, and expanded services at UH Ahuja Medical Center, UH Chagrin Highlands Health Center and UH Westlake Health Center, top-ranked subspecialists provide access to patients closer to home. The division s internationally renowned investigators continue to boast a robust and rapidly growing research portfolio including basic, translational and clinical research activities with a strong focus on inflammatory bowel disease (IBD) and gastrointestinal and esophageal cancers. Over the next five years, the total federal awarded cost secured by our investigators exceeds $30 million and only continues to grow. In addition to the federal research, the division is taking part in many industry-sponsored clinical trials, offering our patients access to leading-edge therapies in the treatment of IBD, hepatitis and liver cancers, just to name a few. Our highly competitive fellowship and education program ensures the sustainability and progress of our clinical and research activities by attracting the top national and international trainees for 12 clinical gastroenterology, one advanced endoscopy and one research fellowship, respectively. In the first quarter of 2013, the American Society of Gastrointestinal Endoscopy awarded Richard Wong, MD, Medical Director of Endoscopy, the Distinguished Endoscopic Mentoring Award. This prestigious honor, awarded to only one educator annually, is a reflection of the best-in-class education our medical graduates receive. 5

8 General Internal Medicine and Geriatrics Rajesh Chandra, md Division Chief General Internal medicine and Geriatrics Our faculty are proud of their contributions to medical education and patient care and remain committed to providing high-quality health care, while teaching and developing a culture of safety and accountability among trainees. As part of its core mission, the Division of General Internal Medicine and Geriatrics seeks to provide high-quality comprehensive patient care, maintain high standards of medical education, and pursue health services research and clinical inquiry. The division is home to a diverse group of internists whose professional interests span across multiple areas, including health care services and outcomes research, hospital medicine, primary care education, population health, acute and long-term care of elderly, palliative care, patient safety and quality improvement, health care disparities, cancer screening and cancer genetics, sleep medicine and medical education. Academic year 2012/2013 proved to be another productive year for the division. Once again this year four of our faculty members were featured in Cleveland Magazine s Best Doctors honor list. The Center for Geriatric Medicine at University Hospitals Case Medical Center, through its ongoing recruitment and development in geriatrics research and palliative care, achieved a rank of 21st in the nation by U.S.News & World Report Best Hospitals rankings. In the area of Hospital Medicine, the UH Case Medical Center Hospitalist service s mortality index (observed/expected) of 0.38 was one of the lowest in the University Hospitals Consortium and was ranked 28 out of 121 hospitals. The average length of stay of 5.3 days also remained below the consortium average of 5.5 days. The Veterans Affairs Center of Excellence in Primary Care, one of five federally funded centers in the nation, continued its innovative work in primary care education and was noted to be a site of numerous best practices by the Veterans Affairs Office of Academic Affiliations. Looking ahead to 2013/2014, issues such as patient satisfaction, patient safety and physician accountability, as well as an increasingly frugal health care spending environment, will continue to shape how we practice clinical medicine. It will be crucial for our clinician educators to incorporate these values into medical education and, as part of that effort, the division will be looking into creative innovations in inpatient clinical care and training and will also explore the emerging concepts of a patient-centered medical home in primary care delivery and education. Our faculty are proud of their contributions to medical education and patient care and remain committed to providing high-quality health care, while teaching and developing a culture of safety and accountability among trainees. 6

9 Neal Meropol, md Division Chief Hematology and Oncology Hematology and Oncology With more than 60 members, the Division of Hematology and Oncology is among the largest within the Department of Medicine, and has a scope of activities that span our research, patient care and educational missions. Our nationally recognized faculty members have expertise and interest in benign hematologic conditions, including coagulation disorders and hemoglobinopathies, as well as hematologic and solid tumor malignancies. Our faculty members include physician-scientists and PhDs conducting laboratory research, as well as clinical researchers and clinical members focused on patient care and teaching. In addition to training medical students, basic science graduate students, post-docs and medical residents, we have an ACGME-accredited Hematology and Oncology fellowship program. We provide care at the University Hospitals Case Medical Center main campus, the Louis Stokes Cleveland VA Medical Center, and through a vast regional network of community practices, all of which participate in clinical trials research. Nineteen of our division members were recognized as Best Doctors by Cleveland Magazine in The Division of Hematology and Oncology is closely aligned with University Hospitals Seidman Cancer Center, a principal member of the NCI-designated Case Comprehensive Cancer Center (which successfully renewed its NCI P30 support grant in 2013) and our faculty play key roles in cancer center research and clinical activities. In 2013, UH Seidman Cancer Center was recognized as one of the top 15 cancer hospitals by U.S.News & World Report. The overall goal of the Division of Hematology and Oncology is to advance the field through clinical and basic research, while providing innovative leading-edge clinical care, and training the next generation of leaders in hematology and oncology. We are a research-intensive division, conducting wet-lab, dry-lab and clinical investigation. Our research efforts follow six general themes: 1) hematology and vascular biology; 2) cancer cell biology; 3) developmental therapeutics and translational research; 4) cancer genetics and genomics; 5) hematologic malignancies; and 6) patient decision-making and health services research. Division members hold an NCI U01 grant for Phase I clinical investigation, an NCI Phase II contract, and an NCI Specialized Program of Research Excellence (SPORE) award for translational research in gastrointestinal cancers. Our faculty also oversee an NCI-funded K12 training program for clinical investigators, and an NCI-sponsored T32 cancer biology training program. The overall goal of the Division of Hematology and Oncology is to advance the field through clinical and basic research, while providing innovative leading-edge clinical care, and training the next generation of leaders in hematology and oncology. A variety of honors and awards were received by our division members in 2012/2013. These include: n Led by Stanton Gerson, MD, the Case Comprehensive Cancer Center received an outstanding score from NCI on its five-year P30 grant renewal. n Nathan Berger, MD, received the Maurice Saltzman Award from the Mount Sinai Foundation for impact on health in Cleveland, OH. n Stanton Gerson, MD, was awarded Case Western Reserve Medal of Excellence in Health Science Innovation, and named Distinguished University Professor. n Sanford Markowitz, MD, PhD, was named Distinguished University Researcher. n Afshin Dowlati, MD, received the Michaele C. Christian Oncology Development Award from NCI Cancer Therapy Evaluation Program. n Neal Meropol, MD, was elected to the American Society of Clinical Oncology Board of Directors. n Matthew Cooney, MD, received the International Fellowship Award from the ASCO Conquer Cancer Foundation to sponsor a year-long training program for a visiting physician from Uganda. 7

10 Infectious Diseases and HIV Medicine Robert Salata, md Division Chief Infectious Diseases and HIV medicine Executive Vice-Chairman Department of Medicine Our division s major research strengths include basic, translational and clinical research in HIV/AIDS, tuberculosis, antimicrobial resistance, infections in elderly, as well as biodefense and emerging infections. Research funding in the Division of Infectious Diseases and HIV Medicine remains strong at over $24 million, despite the recent challenges. Our work includes several major programs: AIDS Clinical Trials Unit, Microbicides Trials Network, Oral HIV/AIDS Research Consortium, TB Research Unit, Phase I Clinical Trials Unit for Therapeutics and Emerging Infections, and Geriatrics Research (GRECC) based at the Louis Stokes Cleveland VA Medical Center. Our division s major research strengths include basic, translational and clinical research in HIV/AIDS, tuberculosis, antimicrobial resistance, infections in elderly, as well as biodefense and emerging infections. Through the Steris Foundation, additional funding of $200,000 per year was secured to support research projects of investigators from area hospitals. Our division has been receiving funding from the foundation for more than 12 years; 53 awards have been made to investigators from 10 departments, and 54 publications resulted from this research. Additional funding has been procured for 34 of the Steris initiatives, including 17 from the NIH. The Infectious Diseases and Immunology Institute, established to strengthen research in the priority areas of virology, clinical research and molecular diagnostics, received support from Case Western Reserve University School of Medicine to aid in accomplishing its goals. A new website for the institute has been developed, and the first pilot grants were awarded to faculty for interdisciplinary research. An interdisciplinary course for high-level undergraduates and graduate/medical students is currently underway. Additionally, there are plans to create an Infectious Diseases Drug Development Center. A new systemwide Antimicrobial Stewardship Program is in the process of being developed and will include oversight by the division s faculty. These activities will also provide an additional venue for operational and clinical research. The inpatient service provides health care for patients with HIV and other infectious diseases and accommodates admissions for over 100 patients a month. There are now two infectious diseases consult services with approximately 135 consults per month. Our community-based physicians continue to provide excellent care for the inpatient population at UH Ahuja Medical Center and UH Richmond Medical Center, a campus of UH Regional Hospitals. The division performed at greater than 75th percentile for wrvus, and no physician fell below the 50th percentile. The division s outpatient activities have greatly expanded since the implementation of the General Infectious Diseases and Travelers Clinic in Westlake, and a transplant Infectious Diseases clinic staffed by divisional faculty with specialty interests. The Special Immunology Unit received additional federal funding from the Ryan White program to maintain the highest quality care for HIV-infected patients. Our fellowship program is thriving and currently has 12 trainees. The program offers a master s in Epidemiology and Public Health, while providing outstanding training with diverse faculty members who boast extensive research and clinical experience. 8

11 Donald Hricik, md Division Chief Nephrology and Hypertension Nephrology and Hypertension The Division of Nephrology and Hypertension has once again been recognized for its outstanding clinical care by U.S.News & World Report for Best Hospitals. Our group of experienced clinicians excels in renal replacement therapy, providing care to more than 400 hemodialysis patients throughout Northeast Ohio. Home hemodialysis (both peritoneal dialysis and home hemodialysis) is a unique University Hospitals Case Medical Center-based program empowering patients to conduct daily home-based treatments. The division s longstanding relationship with the Centers for Dialysis Care (CDC) and their allied Leonard C. Rosenberg Renal Research Foundation culminated this year with a Master Clinician endowment that was awarded to Thomas Hostetter, MD, on behalf of the CDC and the Rosenberg Foundation. In addition, Dr. Hostetter continues to serve as Chairman of the Public Policy Committee for the American Society of Nephrology. Members of the division play key roles in the kidney and pancreas transplant programs at UH Transplant Institute, including active participation in an outreach clinic that provides services for the evaluation of potential transplant recipients in Akron, Ohio. Clinical collaboration between UH Case Medical Center and the Louis Stokes Cleveland VA Medical Center continues to be strong with Mahboob Rahman, MD, named Section Chief at the Louis Stokes Cleveland VA Medical Center. The ultimate goal of the division is to prepare tomorrow s academic physicians, scientists and clinical educators to continue our legacy. The division has provided major leadership for key NIH-sponsored multicenter research trials including the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial; the African-American Study of Kidney Disease and Hypertension; the Chronic Renal Insufficiency Cohort, a study focusing on uremic toxins and factors that influence the progression of chronic kidney disease; and the NIH-sponsored SPRINT Trial. UH Case Medical Center is a leading participant in a multicenter consortium enrolling patients into the NIH s Clinical Trial in Organ Transplant initiative, evaluating the utility of noninvasive immune monitoring tests to facilitate individualization of immunosuppression in kidney transplant recipients. Donald Hricik, MD, presented the pivotal findings of the Clinical Trial in Organ Transplant at the 2013 American Transplantation Congress on behalf of the consortium of nine centers in North America. The division has a successful training program for clinical nephrology fellows and an NIH training grant for the training of physician-scientists. We are also accredited by the American Society of Transplantation to train fellows in transplant nephrology. Our trainees benefit from both bench and translational opportunities in a multidisciplinary environment including the departments of medicine, pathology, physiology and biophysics. The ultimate goal of the division is to prepare tomorrow s academic physicians, scientists and clinical educators to continue our legacy. 9

12 Pulmonary, Critical Care and Sleep Medicine Robert Schilz, do, phd Interim Division Chief Pulmonary, Critical Care and Sleep Medicine Our faculty members continue to be dedicated to providing state-of-the-art patient care, performing leading-edge research, proving to be forward thinkers in clinical care, and developing the next generation of leaders through our highly competitive fellowships. The Division of Pulmonary, Critical Care and Sleep Medicine at University Hospitals Case Medical Center has a long history of clinical excellence and research leadership with national recognition in a number of areas. The division has once again been named to the top 50 pulmonary divisions in the United States by U.S.News & World Report. The Medical Intensive Care Unit is seen as a national leader in critical care, recognized with an unprecedented fifth consecutive American Association of Critical-Care Nurses Beacon Award, the only ICU in the nation to achieve such recognition. Furthermore, several of our physicians remain named among Best Doctors by Cleveland Magazine. Our faculty members continue to be dedicated to providing state-of-the-art patient care, performing leading-edge research, proving to be forward thinkers in clinical care, and developing the next generation of leaders through our highly competitive fellowships. Clinical activities center around our core services of pulmonary medicine, critical care and sleep medicine. Within these core areas, subspecialty centers of clinical excellence include lung cancer, asthma, lung transplantation, pulmonary vascular disease, tuberculosis, cystic fibrosis, interventional bronchoscopy, sleep, emphysema and pulmonary rehabilitation, and critical care. Extending these services to the community continues to be a focus of the division and the reach of the services has specifically broadened in the area of sleep medicine under the direction of our newest faculty member, Colleen Lance, MD, who is directing Clinical Sleep operations. The division supports a broad-based research enterprise from basic to clinical and translational science with a vigorous faculty research core representing epidemiology, physiology, neuroscience, cell and molecular biology. We have active research programs in pulmonary vascular function, inflammation, control of ventilation, genetics of ventilation, epidemiology of pulmonary disorders, tuberculosis, and lung cellular and innate immunity. A clinical trials unit within the division supports investigation of novel therapies for the treatment of such diseases as pulmonary hypertension, chronic obstructive pulmonary disease, sepsis, pulmonary fibrosis and sleep apnea. Divisional faculty have served on NIH Study sections, American Lung Association grant review committees, foundation grant review committees, numerous editorial boards, as well as national and international meetings related to health care and clinical and basic science investigation. The division is proud of the extensive support from the NIH with numerous individual research grants, a cluster grant, and a training grant that supports graduate students as well as PhD and MD postdoctoral fellows. 10

13 Ali Askari, md Division Chief Rheumatology Rheumatology The Division of Rheumatology delivers the most advanced diagnostics and therapeutic treatments for personalized care of rheumatic diseases. The division treated over 8,000 patients in This year the division s chief, Ali Askari, MD, received the American College of Rheumatology Master Designation, an honor bestowed on a select few rheumatologists each year for their contributions to education, research and the well-being of patients with rheumatic diseases. The Division of Rheumatology at University Hospitals Case Medical Center is widely recognized as a center for superb health care, offering unsurpassed medical training and leading-edge clinical research. With a high demand for rheumatologists, the division increased its number of faculty members in 2012 and can now provide new solutions and care for more patients in Northeast Ohio. The division offers specialized treatment through its renowned centers: n The Sjögren s Syndrome Center provides the highest standard of service for Sjögren s patients and has recently created a database of information on patients. Through its multispecialty team of physicians, including staff from ophthalmology, otolaryngology, neurology, urology, dental medicine, gynecology, gastroenterology and pathology, the center helps patients receive the highest quality of care. n The Osteoporosis Center diagnoses and treats osteoporosis patients at nearly any stage. Certified DEXA Scan technologists perform bone density scans, limiting radiation exposure to just 10 percent of the radiation used during a standard chest X-ray. Bone density results are then discussed in professor rounds for final approval and increased accuracy. n The Infusion Center offers advanced care for infusions of biologic agents that provide leading-edge treatment of rheumatic diseases. n The Rheumatology Chemotherapy Treatment Clinic at the Louis Stokes Cleveland VA Medical Center is known for advanced care of rheumatic diseases. The Division of Rheumatology at University Hospitals Case Medical Center is widely recognized as a center for superb health care, offering unsurpassed medical training and leadingedge clinical research. Research in the Division of Rheumatology comprises both academic and externally funded basic research, culminating in significant contributions to the world s biomedical research literature. The Division of Rheumatology at UH Case Medical Center is devoted to discovering new solutions for patients with osteoarthritis, rheumatoid arthritis and related rheumatic disorders. The division has published more than 70 peer-reviewed papers since In addition to clinical practices at 14 sites in the greater Cleveland area and leading clinical research on rheumatic disorders and related conditions, the division continues to focus on education. We have a model fellowship program that received its full accreditation with commendation by the Accreditation Council for Graduate Medical Education in 2005 and continued accreditation in Over the past four decades, more than 50 highly qualified rheumatologists graduated from the program and were certified in internal medicine and the subspecialty of rheumatology, and most of them are currently successfully practicing academic medicine and clinical research across the country. 11

14 Veterans Affairs Robert Bonomo, md Vice-Chairman Veterans Affairs Our core missions are to provide high-quality patient-centered care to more than 100,000 veterans in Northeast Ohio, educate the next generation of health-care providers, and generate new knowledge through research programs. Our core missions are to provide high-quality patient-centered care to more than 100,000 veterans in Northeast Ohio, educate the next generation of health-care providers, and generate new knowledge through research programs. The General Internal Medicine division (Sarah Augustine, MD, Section Chief) encompasses primary care services, inpatient hospital medicine, and specialized women s health clinics. A Center of Excellence in primary care delivery, quality, implementation science and translational research are present. The Cardiology section (Jose Ortiz, MD, Section Chief) is a major referral center. The section has earned the AHA Heart Failure Gold Plus Quality Achievement Award. The Pulmonary, Critical Care and Sleep Medicine section (Frank Jacono, MD, Section Chief) takes care of patients with complex lung ailments. Nationally funded programs in ventilation mechanics health and disease, tuberculosis and sleep apnea highlight the research accomplishments of this section. Physicians in the Gastroenterology division (Yngve Falck-Ytter, MD, Section Chief) are leading the country in the establishment of evidence-based guidelines in the screening and treatment of Hepatitis C patients in collaboration with the United States Centers for Disease Control and Prevention and World Health Organization. The Endocrinology section (Ajay Sood, MD, Section Chief) offers care in the area of diabetes. The Diabetes Registry and the ReSPECT trial actively enrolled patients in research protocols to improve the care of patients suffering from diabetes. The section of Geriatrics (Thomas Hornick, MD, Section Chief) is expanding services to a new state-of-the-art community living center and has research programs that address patient-centered care of the hospitalized elderly, Vitamin E and memantine, role of PET scan in diagnosis of HIV-associated neurocognitive disorders, and management of delirium. The Nephrology section (Mahboob Rahman, MD, Section Chief) conducts clinical and research programs in hemodialysis, chronic ambulatory peritoneal dialysis, continuous venous hemofiltration and kidney transplantation. In addition, nationally recognized research in hypertension and chronic renal diseases is in progress. The Infectious Disease service (Usha Stiefel, MD, Section Chief) is a nationally recognized leader in the management of C. difficile, Methicillin-resistant Staphylococcus aureus, and the molecular epidemiology of bacterial drug resistance. Federally funded research spans bacterial, viral, parasitic and mycobacterial diseases. The Hematology and Oncology section (Lisa Arfons, MD, Section Chief) contains centers dedicated to the multidisciplinary care of complex medical and surgical patients with cancer, and is a national leader in the implementation of a novel program that optimizes timely diagnosis and treatment of patients with lung cancer. The Louis Stokes Cleveland VA Medical Center fosters a rich academic environment dedicated to training research leaders of tomorrow. This year the medical service has two physician-scholars involved in the Clinical and Translational Science Collaborative at Case Western Reserve University School of Medicine. 12

15 Keith Armitage, md Vice-chairman education Educational Programs Clerkship, Residency Program and Subspecialty Fellowships University Hospitals Case Medical Center and the Louis Stokes Cleveland VA Medical Center serve as the major teaching venues for our training programs. Department of Medicine faculty remain active participants in medical student teaching, contributing nearly 12,000 hours annually to the third-year core clerkship, basic science curriculum and fourth-year students combined. This represents approximately 30 percent of total faculty teaching time at Case Western Reserve University School of Medicine. UH Case Medical Center and the Louis Stokes Cleveland VA Medical Center remain the teaching hospitals of choice for students doing their medical clerkships and acting internships in internal medicine. Our residency program is based on two themes: patient care and career development. Our residents continue to succeed in academic careers, successfully competing for the most prestigious and rigorous fellowships or preparing for life as general internists. While the majority of residents still seek subspecialty training, a growing number are opting to enter careers focused on ambulatory primary care practice. Noted below are select accomplishments from academic year 2012/2013. The 2013 residency match was highly successful, with a significant increase in total applicants, record number of interviewees and vibrant incoming class. n The 2013 residency match was highly successful, with a significant increase in total applicants, record number of interviewees and vibrant incoming class. n University Hospitals and the Louis Stokes Cleveland VA Medical Center rotation was by a wide margin the top choice for Case Western Reserve University medical students for completing their internal medicine acting internships, with 82 students choosing this rotation in 2012/2013. n Student and resident participation at regional and national meetings was at an all-time high in 2012/2013. n The leaders of our student and resident education programs continued to be active at national meetings on education, with six presentations and workshops in 2012/2013. In addition to these core accomplishments, the continuing education component of the educational program remains strong. As examples, the annual Department of Medicine Research Day included poster presentations by 48 residents and attendance by over 120 house staff, fellows and faculty. Department of Medicine faculty members remain a central component in the CME programs as activity leaders for eight regional and national programs. 13

16 Research Thomas Hostetter, md Vice-Chairman research The Department of Medicine is focused on fostering a rich scientific environment dedicated to training research leaders and shaping the intellectual discourse of tomorrow. The Department of Medicine is focused on fostering a rich scientific environment dedicated to training research leaders and shaping the intellectual discourse of tomorrow. Research within the Department of Medicine remains vigorous. Total grant support was approximately $54 million for the year with an additional $13 million going to the Case Comprehensive Cancer Center, which houses many of the department s researchers. These funds derive from multiple government and nonprofit granting agencies as well as from industry. Eight new grants accounted for nearly $3 million of new award money. Several significant awards reside within the Department of Medicine. Henry Boom, MD, heads the Tuberculosis Research Unit. Michael Lederman, MD, runs the AIDS Clinical Trials Unit, which encompasses international work in Uganda. The SPRINT trial of optimal blood pressure control is directed in this region by Jackson Wright, MD, PhD. Sanford Markowitz, MD, PhD, is the principal investigator for a recently awarded Specialized Program of Research Excellence (SPORE) focusing on gastrointestinal malignancy. John Johnson, MD, directs an international effort of the Centers for Disease Control and Prevention aimed at improving the treatment of tuberculosis. In February, the Department of Medicine held its annual Research Retreat. The aims of the retreat were review of current research efforts across the spectrum of basic, translational and clinical areas, their sources of support and the development of novel strategies for enhancing the department s research in the future. Approximately 75 faculty and staff members attended the meeting including those from University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center and other departments. Among the identified goals were a research committee, departmental support for team projects, and enhancement of the Residents Research Pathway. In May, the annual Research Day attracted over 80 poster presentations authored by residents, fellows, graduate students, postdoctoral students and junior faculty. Three superb presentations by young faculty Frank Jacono, MD, Evi Stavrou, MD, and Brandon Atkins, MD, PhD highlighted the day. 14

17 Jonathan Stamler, md Director UH Harrington Discovery Institute University Hospitals Harrington Discovery Institute University Hospitals launched the Harrington Discovery Institute at University Hospitals Case Medical Center early in 2012 through the generous support of the Harrington family. Part of The Harrington Project for Discovery & Development, a $250 million national initiative dedicated to physician-scientists, the Harrington Discovery Institute seeks to help transform scientific discoveries into therapies that improve patient outcomes and save lives. Year-in-review highlights include recruitment of a Scientific Advisory Board led by some of the nation s most accomplished scientific innovators, creation of the Innovation Support Center comprised of expert leadership from pharmaceutical companies to advance drug development, naming Mukesh Jain, MD, the Scientific Director of the Harrington Discovery Institute and Perry Molinoff, MD, the Director of the Innovation Support Center. The Harrington Discovery Institute seeks to help transform scientific discoveries into therapies that improve patient outcomes and save lives. To carry out its mission of advancing promising discoveries by physicians, the Harrington Discovery Institute has established several granting mechanisms, including the Harrington Distinguished Scholar, Harrington Scholar-Innovator Grant, Foundation Scholar and University Consortium Scholar programs and, in April 2013, announced the creation of the Harrington Prize for Innovation in Medicine. Goutham Narla, MD, PhD, formerly Assistant Professor, Icahn School of Medicine at Mt. Sinai, New York, and current member of the Institute for Transformative Molecular Medicine, was selected as the first Harrington Distinguished Scholar (Early Career Award). The Scientific Advisory Board selected the first class of 10 Harrington Scholar-Innovators, physician-scientists engaged in laboratory research with the potential to be translated into breakthrough clinical advances. Each receives financial support and access to Harrington Discovery Institute resources. The second annual call for proposals for the Harrington Scholar-Innovator Grant generated a remarkable response by the May 2013 deadline. The 2014 class will be announced by the end of In April 2013, the American Society for Clinical Investigation (ASCI) and Harrington Discovery Institute jointly announced the 2014 Harrington Prize for Innovation in Medicine, a $20,000 honorarium to a physician-scientist who has moved science forward with achievements notable for innovation, creativity and potential for clinical application. Nominations were accepted through June In celebration of the first year s efforts, the inaugural Harrington Scientific Symposium was held in early May in Cleveland. The symposium featured presentations from the Harrington Scholar-Innovator Grant awardees, and brought together leadership from the American Society for Clinical Investigation, commercialization experts and policy specialists. 15

18 Departmental Administration Frederick Creighton, mha, facmpe, fache Director Administration The principal goals of department administration are to facilitate the success of the full-time faculty, use decades of collective experience in advancing managerial effectiveness, and to continue to seek creative solutions to increasing complex operational challenges. The principal goals of department administration are to facilitate the success of the full-time faculty, use decades of collective experience in advancing managerial effectiveness, and to continue to seek creative solutions to increasing complex operational challenges. Academic Year 2012/2013 included several notable achievements for department and divisional administration. First and foremost, the administration has successfully supported the strong financial stewardship of over $200 million in operating, research, philanthropic and developmental resources. Strong performance in traditional administrative areas such as grant management, business planning, mentorship, recruitment and clinical operations has contributed to moving our complex academic enterprise forward. Less traditional areas such as e-media communications, web design and social networking help strengthen professional and referral relationships, and have set the standard for several new ways of supporting the department and health system development. In addition to financial and human resource management, several significant operational changes, including the implementation of the Athena professional fee billing platform and scheduling system, and the Allscripts ambulatory electronic health record, required much added time and effort. Planning, designing new work flows, refining educational and training content, and shaping implementation strategies all relied heavily upon the input and involvement of the Department of Medicine administration. As health care reform continues, heightened patient consumerism will take center stage, and general economic conditions will continue to pose challenges for the department s administrative team. I commend this dedicated group of individuals on their ongoing commitment and creativity. 16

19 Faculty and Budget Trends The Department of Medicine is proud of its large, diverse faculty. Recent recruitment trends have equally favored the clinical-scholar and physician-scientist. The budgetary sources that support the faculty are well-balanced between research, the clinical practice of medicine and our institutions. Overall, the Department of Medicine self-funds approximately 85 percent of its research, clinical and educational missions. 1 FULL-TIME FACULTY TRENDS FY 12/ Clinician-Educators FY 11/ Physician-Scientists FY 10/ Research-Scientists Others Total FY 12/ FY 11/ FY 10/ Female Male Total FY 12/ FY 11/ FY 10/ African-American Mid-East/Asian Hispanic Caucasian Total 2 FACULTY COMPENSATION FUNDING 7% 13% 6% 12% 10% 8% 7% 12% 9% UH Case Medical Center SOM Research 41% 13% 39% 11% 42% 12% VAMC Faculty Practice Other Sources 20% 20% 18% FY 10/11 FY 11/12 FY 12/13 3 OPERATING BUDGET SOURCES 25% 2% 17% 7% 27% 3% 15% 7% 27% 4% 13% 7% UH Case Medical Center SOM Research VAMC Clinical Income 12% 37% 13% 35% 12% 37% Other Sources FY 10/11 FY 11/12 FY 12/13 17

20 Research Funding The Department of Medicine s MD and PhD faculty who are oriented toward basic, translational and applied research again demonstrated a high level of productivity and quality during academic year 2012/2013. This success is measured by both quality and quantity of research applications sent to various granting agencies, as well as the success rate and amount of structured funding that is obtained from these agencies. 4 RESEARCH APPLICATIONS TOTAL COST in Millions of Dollars FY 12/ FY 11/ FY 10/ TOTAL RESEARCH EXPENDITURES (Direct Costs) in Millions of Dollars FY 12/13 FY 11/12 FY 10/ NIH VA Other Federal Nonfederal Total 6 AWARDED TOTAL COST BY DIVISION in Millions of Dollars CV MEDICINE CLINICAL PHARM FY 12/ FY 11/ FY 10/ FY 12/13.26 FY 11/12.45 FY 10/11.48 ENDO- CRINOLOGY FY 12/ FY 11/ FY 10/ GI FY 12/ FY 11/ FY 10/ GEN MED FY 12/13 0 FY 11/12.31 FY 10/11.59 HEM/ONC FY 12/ FY 11/ FY 10/ ID/HIV MEDICINE NEPHROLOGY/ HYP PULMONARY/ CC/SLEEP RHEUMA- TOLOGY CANCER CENTER GRANT FY 12/ FY 11/ FY 10/ FY 12/ FY 11/ FY 10/ FY 12/ FY 11/ FY 10/ FY 12/13.46 FY 11/12 0 FY 10/11.20 FY 12/ FY 11/ FY 10/

21 Education and Clinical Service The Department of Medicine s educational and clinical programs remain robust. One metric used to evaluate clinical service volume are work relative value units (wrvu). Each clinical service delivered to a patient carries a corresponding wrvu based on complexity. A second measure of program growth is clinical collections from patient care services. These metrics for our clinically oriented faculty continue to trend upward. The full-time faculty of the department continue to provide the majority of medical student teaching contact hours. The house staff program enjoyed another outstanding group of residents and fellows and continues to be the premier training program. 7 RVU AND CLINICAL COLLECTIONS TREND wrvus Clinical Collections CY 2010 CY 2011 CY 2012 CY 2010 CY 2011 CY 2012 Cardiovascular Medicine 182, , ,480 $9,494,967 $10,100,887 $10,814,110 Endocrinology 13,634 12,506 12,713 $885,309 $859,293 $967,221 Gastroenterology 55,203 67,512 71,630 $3,161,674 $3,675,480 $4,133,167 General Medicine 48,752 49,406 54,190 $2,019,440 $2,194,246 $2,784,156 Geriatrics 10,670 8,022 4,198 $543,345 $420,801 $139,255 Hem/Onc 71,824 73,799 73,915 $3,423,729 $3,223,735 $3,370,983 ID/HIV Medicine 40,129 42,484 38,710 $1,947,933 $2,111,523 $2,070,563 Nephrology 39,727 41,520 40,807 $1,944,638 $1,967,948 $1,935,428 Pulmonary/CC/Sleep 48,381 51,109 50,297 $2,311,413 $2,415,797 $2,348,154 Rheumatology 13,243 14,008 12,674 $1,648,867 $1,673,409 $1,703,202 Totals 523, , ,614 $27,381,315 $28,643,119 $30,266,239 8 STUDENT TEACHING TIME Third-Year Core Clerkship Students Basic Science Curriculum Fourth-Year Students 3,120 hours* 2,200 hours 3,080 hours* *25 percent direct contact time Total hours represents approximately 30 percent of total faculty teaching time in the School of Medicine 9 COMPOSITION OF THE HOUSE STAFF FY 12/ Categorical FY 11/ FY 10/ Special Programs International Health, Med/Peds, Med/Genetics Fellows 19

22 Significant Accomplishments 2012/2013 Research n Awarded $495,000 to investigate the role of KLF 15 in vascular disease. n Awarded $374,000 to research CCN3 and aortic aneurysm. n Awarded $278,000 to study recombinant human bone morphogenetic protein-2 and cancer risk. n Awarded $276,000 to identify the most effective glycemia reduction approaches in diabetes. n Newly enhanced Residency Research Pathway, Harrington Physician-Scientist Pathway, develops a new generation of leaders in medicine by offering training in basic, clinical and translational research. Clinical n Sixty-eight Department of Medicine faculty members recognized as Best Doctors by Cleveland Magazine. n Dramatically enhanced clinical alignment between the health system primary care network and the full-time faculty. n Leadership roles in new clinical support initiatives, including patient access, professional fee billing system replacement and ambulatory electronic medical record implementation. n Year-over-year hospital and ambulatory service growth in all previously identified strategic priority areas. n New media efforts focused on familiarizing patients with their physicians resulted in increased patient satisfaction scores. Education n Fully redesigned the Internal Medicine Residency Program website, launched new content and user functions. n University Hospitals Case Medical Center and the Louis Stokes Cleveland VA Medical Center rotation was the top choice for students doing internal medicine clerkships and acting internships. Department of Medicine contributes over 8,000 hours annually to student teaching. n Multiple presentations at national meetings by Department of Medicine educational leaders. n Highly successful residency match with the majority of qualified applicants from LCME-accredited schools, and a record number of candidates interviewed. All National Institutes of Health (NIH) funding for basic and clinical research is awarded to the School of Medicine at Case Western Reserve University. 20

23 U.S.News and World Report Rankings 2011/ / /2014 Cardiology 36th Cancer 39th Diabetes & Endocrinology 25th Gastroenterology 23rd Geriatrics 47th Nephrology 33rd Pulmonary 29th Cardiology 18th Cancer 38th Diabetes & Endocrinology 14th Gastroenterology 27th Geriatrics 31st Nephrology 38th Pulmonary 19th Cardiology 15th Cancer 26th Diabetes & Endocrinology 13th Gastroenterology 21st Geriatrics 22nd Nephrology 38th Pulmonary medicine.case.edu 21

24 compassionate clinical care with innovative research and outstanding education Case Western Reserve University School of Medicine is ranked in the Best Medical Schools in America by U.S.News & World Report University Hospitals Case Medical Center is one of only 18 hospitals nationwide named to the prestigious U.S.News & World Report Best Hospitals Honor Roll medicine.case.edu Department of Medicine University Hospitals Case Medical Center Euclid Avenue Cleveland, Ohio