JamesLHollyMD.com

	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
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A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - 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About SETMA - Special Services - Education Department

Special Services

All education is based on learning how to make healthy lifestyle changes in order to promote overall health and prevent or help treat complications arising from health conditions.

Diabetes Education:

This is an intensive self-management program that follows guidelines set forth by the American Diabetes Association. It consists of an initial one-on-one assessment by a diabetes educator (either a registered nurse or dietitian), group classes, and a one-on-one follow-up visit. Patients will be taught all of the ten content areas; including diabetes disease process, monitoring, psychosocial adjustment, medication, nutritional management, physical activity, goal setting and problem solving, and the prevention, detection, and treatment of acute and chronic complications through risk reduction. Behavior modification is a major focal point of the program in order to assist the patient in preventing the complications of diabetes.

Cholesterol Management:

Content will include review of what is cholesterol (the good, the bad, and the ugly), and how it contributes to CVD, lab tests used in scoring cholesterol levels, management and appropriate goals and how medications are used to treat cholesterol. The patient will learn how to achieve a desirable blood cholesterol level, incorporate lifestyle changes including physical activity and a healthy eating pattern in order to reduce the risk of CVD, and achieve a desirable blood pressure level.

Weight Management:

The weight management class is taught by a registered dietitian in a supportive environment where patients will learn what effects appetite and causes weight gain, individual social and behavioral triggers to eating, health conditions that are more prominent with excess weight, and positive lifestyle changes that can promote weight loss and an improved quality of life. The patient will learn what works in long-term, successful weight loss. Each participant will be provided with an individual meal plan , learn how to read labels, understand portion sizes, good foods to choose, and have an opportunity to continue with individual follow-up visits.

Dietary Approaches to Stop Hypertension:

This class focuses on learning the DASH eating style which has been clinically demonstrated to help lower blood pressure.

Metabolic Syndrome:

Content includes definition of what is metabolic syndrome, identification of risk factors for development of metabolic syndrome as well as the risk associated with having metabolic syndrome. Lab value targets for glucose and lipid control will be discussed. Patients will be educated on making lifestyle changes necessary to decrease their risk of cardiovascular disease and diabetes through medication management, nutrition, exercise, weight management and cessation of smoking.

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