{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:55:16Z","timestamp":1791536116926,"version":"4.3.4"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:sec id=\"ab-doi240068-4\"><jats:title>Importance<\/jats:title><jats:p>There is growing awareness of the US health sector\u2019s substantial contribution to the country\u2019s greenhouse gas (GHG) emissions, exacerbating the health threats from climate change. Reducing health care\u2019s environmental impact requires understanding its carbon emissions, but there are few published audits of health systems and fewer comprehensive emissions analyses at the clinic or department level.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240068-5\"><jats:title>Objective<\/jats:title><jats:p>To quantify the annual GHG emissions from a large outpatient dermatology practice, compare relative sources of emissions, and identify actionable targets.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240068-6\"><jats:title>Design and Setting<\/jats:title><jats:p>This quality improvement study involving a comprehensive carbon footprint analysis (scopes 1-3) of a  large (nearly 30\u202f000 visits\/y), outpatient medical dermatology practice within the University of Pennsylvania\u2019s academic medical complex was conducted following the GHG Protocol Corporate and Corporate Value Chain reporting standards for fiscal year 2022 (ie, July 2021 through June 2022). Data were obtained through energy metering, manual audits, electronic medical records, and administrative data.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240068-7\"><jats:title>Exposure<\/jats:title><jats:p>Data were converted into metric tons of carbon dioxide equivalent (tCO<jats:sub>2<\/jats:sub>e), allowing comparison of global-warming potential of emitted GHGs.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240068-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Primary outcomes were tCO<jats:sub>2<\/jats:sub>e by scope 1 (direct emissions), scope 2 (indirect, purchased energy), and scope 3 (indirect, upstream\/downstream sources), as well as by individual categories of emission sources within each scope.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240068-9\"><jats:title>Results<\/jats:title><jats:p>Scope 3 contributed most to the clinic\u2019s carbon footprint, composing 165.5 tCO<jats:sub>2<\/jats:sub>e (51.1%), followed by scope 2 (149.9 tCO<jats:sub>2<\/jats:sub>e [46.3%]), and scope 1 (8.2 tCO<jats:sub>2<\/jats:sub>e [2.5%]). Within scope 3, the greatest contributor was overall purchased goods and services (120.3 tCO<jats:sub>2<\/jats:sub>e [72.7% of scope 3]), followed by patient travel to and from the clinic (14.2 tCO<jats:sub>2<\/jats:sub>e [8.6%]) and waste (13.1 tCO<jats:sub>2<\/jats:sub>e [7.9%]). Steam and chilled water were the largest contributors to scope 2. Clinic energy use intensity was 185.4 kBtu\/sqft.<\/jats:p><\/jats:sec><jats:sec id=\"ab-doi240068-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this quality improvement study, the composition of emissions at the clinic level reflects the importance of scope 3, paralleling the health sector overall. The lower-resource intensity of the clinic compared to the average energy requirements of the total clinical complex led to a relatively large contribution from scope 2. These findings support efforts to characterize high-yield emissions-reduction targets and allow for identification of actionable, clinic-level steps that may inform broader health system efforts.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2024.5669","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T16:00:37Z","timestamp":1736352037000},"page":"191","source":"Crossref","is-referenced-by-count":20,"title":["Carbon Footprint Analysis of an Outpatient Dermatology Practice at an Academic Medical Center"],"prefix":"10.1001","volume":"161","author":[{"given":"Genevieve S.","family":"Silva","sequence":"first","affiliation":[{"name":"Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Waegel","sequence":"additional","affiliation":[{"name":"Weitzman School of Design at the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Kepner","sequence":"additional","affiliation":[{"name":"Hospital of the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Evans","sequence":"additional","affiliation":[{"name":"Hospital of the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Braham","sequence":"additional","affiliation":[{"name":"Weitzman School of Design at the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misha","family":"Rosenbach","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"12","key":"doi240068r1","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.1377\/hlthaff.2020.01247","article-title":"Health care pollution and public health damage in the United States: an update.","volume":"39","author":"Eckelman","year":"2020","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"doi240068r3","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/s11367-021-01998-8","article-title":"Environmental footprint of regular and intensive inpatient care in a large US hospital.","volume":"27","author":"Prasad","year":"2022","journal-title":"Int J Life Cycle Assess"},{"issue":"2","key":"doi240068r4","doi-asserted-by":"publisher","first-page":"e84","DOI":"10.1016\/S2542-5196(20)30271-0","article-title":"Health care\u2019s response to climate change: a carbon footprint assessment of the NHS in England.","volume":"5","author":"Tennison","year":"2021","journal-title":"Lancet Planet Health"},{"key":"doi240068r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.resconrec.2024.107750","article-title":"Assessing waste and carbon impacts of health system at a regional level.","volume":"209","author":"Malik","year":"2024","journal-title":"Resour Conserv Recycling"},{"key":"doi240068r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.resconrec.2019.104525","article-title":"Carbon footprint of Japanese health care services from 2011 to 2015.","volume":"152","author":"Nansai","year":"2020","journal-title":"Resour Conserv Recycling"},{"issue":"6","key":"doi240068r7","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/S1470-2045(24)00148-7","article-title":"Quantification of the environmental impact of radiotherapy and associated secondary human health effects: a multi-institutional retrospective analysis and simulation.","volume":"25","author":"Lichter","year":"2024","journal-title":"Lancet Oncol"},{"issue":"4","key":"doi240068r8","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1093\/ajcp\/aqab021","article-title":"Life cycle greenhouse gas emissions of gastrointestinal biopsies in a surgical pathology laboratory.","volume":"156","author":"Gordon","year":"2021","journal-title":"Am J Clin Pathol"},{"key":"doi240068r9","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jss.2024.04.007","article-title":"A life cycle assessment of reusable and disposable surgical caps.","volume":"299","author":"Donahue","year":"2024","journal-title":"J Surg Res"},{"issue":"5","key":"doi240068r10","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.5811\/westjem.2020.6.47900","article-title":"Dumpster diving in the emergency department.","volume":"21","author":"Hsu","year":"2020","journal-title":"West J Emerg Med"},{"issue":"3","key":"doi240068r11","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.21.0362","article-title":"What can hospitals learn from The Coca-Cola Co? 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