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
Governance Board Governance Board Responsibilities Governance Board Leadership Training The SETMA Team and The SETMA Culture SETMA's Mission, Vision and Goals: Patient Safety and Quality Care Harassment, Neglect, Abuse, Exploitation - Role of HCAHPS & CAHPS Healthcare Provider Standards Providers Responsibility Medication Refills, Reconciliation and Maintenance Provider and Leadership Use of Data and Analytics Commitment To All Patients -- Ethnic Disparities Kaizen - Board Creates Culture of Safety and Quality SETMA's Policy and Practice for Advanced Directives SETMA's Policy on Completion of Medical Records Care Guidelines : Improve processes to evaluate and treat Integrated patient safety program (Sentinel Events) Effectively Manages all programs, services or sites Provides Patients with information about Primary-care Medical Home Organization-wide Planning to Maintain Focus on safety and quality Organization-wide Planning to Maintain Focus on safety and quality SETMA's Performance Quality & Safety Judged by CMS SETMA's Performance Quality & Safety Judged by CMS SETMA Awarded by HIMSS for Quality and Safety 2011 John M. Eisenberg Patient Safety and Quality Awards Application Healthcare Quality Award 2012 Principles of Quality and Metrics Principles Contacting SETMA & Secure Texting PC-MH Mission, Vision, Goal, Access, End-of-Life Communications and Public Reporting Change Existing Processes to Improve Performance Team Members Focused on Safety and Quality	Your Life Your Health View Articles by Subject Aging Well Behavioral Health Cardiovascular Disease Risk Care Coordination Care Transitions Children's Health COGNOS Project Diabetes Exercise Healthcare Reform:Public Policy HIPAA & Security Labor Day Less Initiative Medical Home Medical Records Men's Health Mental Health Nutraceuticals Nutrition Smoking Cessation Thanksgiving Weight Management Women's Health All Articles	Public Reporting Public Reports by Year (2009-2017) Public Reports by Type Fall Risk, Pain, Functional, Wellness, Stress Assessment Fall Risk, Pain, Functional, Wellness, Stress Assessment for 2011 AND 2012 Core Measures: SETMA & Baptist Hospital Core Measures for January to December 2011 PQRS Diabetes Measures - Blood Pressure Diabetes Measures - Glyco and LDL Diabetes Measures - Nephropathy Screening, Foot Exam, and Eye Exam Preventive Measures - Screening (BMI, Colorectal Cancer, Mammography, Osteoporosis) Preventive Measures - Influenza, Pneumococcal, Urinary Incontinence Preventive Measures - Tobacco Use NQF Care for Older Adults Comprehensive CHF Care Diabetes Measures Diabetes Measures - Blood Pressure Control Diabetes Measures - Glyco and LDL Diabetes Measures - Smoking Cessation Female Measures General Health Measures Medication Measures Persistent Medications Medication Measures Pediatric Measures HEDIS (NCQA) Effectiveness of Acute Care Effectiveness of Chronic Care - Clinic/Hospital Effectiveness of Chronic Care - Clinic Only Effectiveness of Chronic Care - Diabetes (Smoking Cessation) Effectiveness of Chronic Care - Diabetes (Glyco and LDL) Effectiveness of Chronic Care - Diabetes (Blood Pressure Control) Effectiveness of Preventive Care Effectiveness of Preventive Care - Older Adults Effectiveness of Chronic Care - Diabetes Measures Effectiveness of Chronic Care - Persistent Medications (MPM) NCQA Diabetes Recognition Program Audit LESS Initiative PCPI PCPI Hypertension PCPI Diabetes PCPI Chronic Stable Angina PCPI Care Transitions PCPI CHF PCPI Weight Management PCPI CKD Stages IV V SETMA Lipid Audit Lipids Treatment Audit Tutorial Lipids Tutorial AQA COGNOS Project SETMA Audit for CKD Stages I III Patient Satisfaction Survey	Accreditations/Awards Achievements which have Advanced SETMA: The Time-line, Philosophy and Principles which Underlie that Advancement Awards	Diabetes Center of Excellence Education Diabetes Order Referral Form Seven Stations 2011 Advances in Diabetes Diabetes Tutorial Diabetes Prevention
EPM Tools Association of Medication and Diagnosis Automated Team Function Behavioral Health Adult Weight Management Tutorial Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Behavioral Health in SETMA's Patient-Centered Medical Home Model of Care Depression Tutorial Fall Risk Tutorial Health Insurance Portability and Accountability Act (HIPAA) Privacy Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive LESS Initiative Tutorial Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Pain Management Tutorial Reduction of Antipsychotic Medications Toolkit Smoking Cessation Tutorial Stratifying End-of-Life Risk for Hospice Services Tutorial Chronic Conditions Tutorial Chronic Renal Disease Management Tool Tutorial Calculating the Stages of Renal Disease Proteinuria Disease Management Tools Acute Coronary Syndrome Tutorial Adult Weight Management Tutorial Angina Tutorial Cardiometabolic Risk Syndrome Tutorial Chronic Renal Disease Tutorial Congestive Heart Failure Tutorial Diabetes Tutorial Hypertension Tutorial Lipids Tutorial Lipid Quality Audit Tutorial Primary Pulmonary Hypertension Tutorial Framingham Cardiovascular Risk Cardiometabolic Risk Assessment Framingham Heart Study Risk Calculators Tutorial Frederickson Classification of Dyslipidemia LDL Level Lipid Disease Management Risk Assessment General principles about ICD-9 Codes and HCC/RxHCC Codes Charge Posting Tutorial Coding to Ensure Accurate Health Risk Scoring E & M Codes Tutorial HCC & RxHCC Risk HCC/RxHCC Risk Tutorial ICD-9 Code Training Manual Hepatitis Screening Hospital Based Tools Hospital Care Summary and Post Hospital Plan of Care and Treatment Plan Tutorial Admission Orders Tutorial Daily Progress Notes Tutorial Care Transition Data Set from PCPI Tutorial Using The Clinic and Hospital Follow-up Call Templates Respiratory Failure Tutorial Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Tutorial for SETMA's Internal HCAHPS Survey Master GP Suite of Templates Master GP Suite of Templates Tutorial Medical Home Support Materials Department of Care Coordination, Director of Care Coordination and Care Coordination Referral Template Electronic Tickler File Electronic Tickler File Tutorial Follow-up Calls Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Medical Home Coordination Review Tutorial Medical Home Plan of Care and Treatment Plan Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Patient-Centered Medical Home Annual Questionnaires Patient-Centered Medical Home: SETMA's Medical Home Coordination Review (MHCR) Tutorial Patient Document for Coordination of Care Transitions of Care Management Coding (TCM Code) Tutorial Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial Nursing Home Depression Tutorial Fall Risk Tutorial Hydration Assessment Tutorial Nursing Home Guidelines for Care Tutorial Nursing Home Principal Suite of Templates Nutrition Assessment Tutorial Reduction of Antipsychotic Medications Toolkit Skin Care Tutorial Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds Preventive Health Tools Adult Weight Management Tutorial CHF Exercise Tutorial Diabetic Exercise Tutorial Diabetes Prevention Tutorial Exercise Prescription Tutorial Hypertension Prevention Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Initial Preventive Physical Exam & Annual Wellness Visit Tutorial LESS Initiative Tutorial Progression to Type 2 Diabetes Smoking Cessation Tutorial Progression to Type 2 Diabetes Quality Metrics ACO and Medicare Advantage Stars HEDIS: NCQA, History, Quality, Safety, STARS, ACO ACO Quality Measures Performance Tool ACO Quality Measures Performance Tool Tutorial STARs - 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 - One form of Care Coordination HCAHPS - Hospital Consumer Assessment Of Healthcare Providers and Systems CAHPS - Consumer Assessment of Health Care Provider and Systems Teaching Tool for PC-MH Course – Patient Care Activation, Engagement, Shared-Decision Making Display & Explanation of PC-MH Tools SETMA's Medical Home Pilgrimage Concierge Medicine not Medical Home Medical Neighborhood Security & HIPPA Referrals Patient Web Portal Health Information Exchange Medication Reconciliation The Automated Team Coordination of Care Medical Home Description & Standards AAAHC Joint Commission NCQA Planetree URAC NCQA Interview February 14, 2014	Facebook	Letters

Your Life Your Health - Prescription Drug Abuse Part II Introduction continued

James L. Holly,M.D.

March 15, 2007

Your Life Your Health - The Examiner

Some Commonly Prescribed Medications: Use and Consequences
Opioids	Barbiturates	Benzodiazepines
Oxycodone (OxyContin, Percodan, Percocet) Propoxyphene (Darvon) Hydrocodone (Vicodin, Lortab, Lorcet) Hydromorphone (Dilaudid) Meperidine (Demerol) Diphenoxylate (Lomotil) Morphine (Kadian, Avinza, MS Contin) Codeine Fentanyl (Duragesic) Methadone CNS Depressants	Mephobarbital (Mebaral) Pentobarbital sodium (Nembutal)	Diazepam (Valium) Chlordiazepoxide hydrochloride (Librium) Alprazolam (Xanax) Triazolam (Halcion) Estazolam (ProSom) Clonazepam (Klonopin) Lorazepam (Ativan) Stimulants Dextroamphetamine (Dexedrine and Adderall) Methylphenidate (Ritalin and Concerta)
Generally prescribed for	Generally prescribed for	Generally prescribed for
Postsurgical pain relief Management of acute or chronic pain Relief of cough and diarrhea	Anxiety Tension Panic attacks Acute stress reactions Sleep disorders Anesthesia (at high doses)	Narcolepsy Attention-deficit hyperactivity disorder (ADHD) Depression that does not respond to other treatment
In the body	In the body	In the body
Opioids attach to opioid receptors in the brain and spinal cord, blocking the perception of pain.	CNS depressants slow brain activity through actions on the GABA system, producing a calming effect.	Stimulants enhance brain activity, causing an increase in alertness, attention, and energy.
Effects of short-term use	Effects of short-term use	Effects of short-term use
Alleviates pain Drowsiness Constipation Depressed respiration (depending on dose)	A "sleepy" and uncoordinated feeling during the first few days; as the body becomes accustomed (tolerant) to the effects, these feelings diminish.	Elevated blood pressure Increased heart rate Increased respiration Suppressed appetite Sleep deprivation
Effects of long-term use	Effects of long-term use	Effects of long-term use
Potential for physical dependence and addiction	Potential for physical dependence and addiction	Potential for physical dependence and addiction
Possible negative effects	Possible negative effects	Possible negative effects
Severe respiratory depression or death following a large single dose	Seizures following a rebound in brain activity after reducing or discontinuing use	Dangerously high body temperature or an irregular heartbeat after taking high doses Cardiovascular failure or lethal seizures For some stimulants, hostility or feelings of paranoia after taking high doses repeatedly over a short period of time
Should not be used with Other substances that cause CNS depression, including	Should not be used with Other substances that cause CNS depression, including	Should not be used with
Alcohol Antihistamines Barbiturates Benzodiazepines General anesthetics	Alcohol Prescription opioid pain medicines Some OTC cold and allergy medications	OTC decongestant medications Antidepressants, unless supervised by a physician Some asthma medications

Trends in the Abuse of prescription drugs

Although prescription drug abuse affects many Americans, some concerning trends can be seen among older adults, adolescents, and women. Several indicators suggest that prescription drug abuse is on the rise in the United States. According to the 2003 National Survey on Drug Use and Health (NSDUH), an estimated 4.7 million Americans used prescription drugs nonmedically for the first time in 2002 -

2.5 million used pain relievers
1.2 million used tranquilizers
761,000 used stimulants
225,000 used sedatives

Pain reliever incidence increased-from 573,000 initiates in 1990 to 2.5 million initiates in 2000-and has remained stable through 2003. In 2002, more than half (55 percent) of the new users were females, and more than half (56 percent) were ages 18 or older.

The Drug Abuse Warning Network (DAWN), which monitors medications and illicit drugs reported in emergency departments (EDs) across the Nation, recently found that two of the most frequently reported prescription medications in drug abuse-related cases are benzodiazepines (e.g., diazepam, alprazolam, clonazepam, and lorazepam) and opioid pain relievers (e.g., oxycodone, hydrocodone, morphine, methadone, and combinations that include these drugs). In 2002, benzodiazepines accounted for 100,784 mentions that were classified as drug abuse cases, and opioid pain relievers accounted for more than 119,000 ED mentions. From 1994 to 2002, ED mentions of hydrocodone and oxycodone increased by 170 percent and 450 percent, respectively. While ED visits attributed to drug addiction and drug-taking for psychoactive effects have been increasing, intentional overdose visits have remained stable since 1995.

Older adults

Persons 65 years of age and above comprise only 13 percent of the population, yet account for approximately one-third of all medications prescribed in the United States. Older patients are more likely to be prescribed long-term and multiple prescriptions, which could lead to unintentional misuse.

The elderly also are at risk for prescription drug abuse, in which they intentionally take medications that are not medically necessary. In addition to prescription medications, a large percentage of older adults also use OTC medicines and dietary supplements. Because of their high rates of comorbid illnesses, changes in drug metabolism with age, and the potential for drug interactions, prescription and OTC drug abuse and misuse can have more adverse health consequences among the elderly than are likely to be seen in a younger population. Elderly persons who take benzodiazepines are at increased risk for cognitive impairment associated with benzodiazepine use, leading to possible falls (causing hip and thigh fractures), as well as vehicle accidents. However, cognitive impairment may be reversible once the drug is discontinued.

Adolescents and young adults

Data from the 2003 NSDUH indicate that 4.0 percent of youth ages 12 to 17 reported nonmedical use of prescription medications in the past month. Rates of abuse were highest among the 18-25 age group (6.0 percent). Among the youngest group surveyed, ages 12-13, a higher percentage reported using psychotherapeutics (1.8 percent) than marijuana (1.0 percent).

The NIDA Monitoring the Future survey of 8th-, 10th-, and 12th-graders found that the nonmedical use of opioids, tranquilizers, sedatives/barbiturates, and amphetamines was unchanged between 2003 and 2004. Specifically, the survey found that 5.0 percent of 12th-graders reported using OxyContin without a prescription in the past year, and 9.3 percent reported using Vicodin, making Vicodin one of the most commonly abused licit drugs in this population. Past year, nonmedical use of tranquilizers (e.g., Valium, Xanax) in 2004 was 2.5 percent for 8th-graders, 5.1 percent for 10th-graders, and 7.3 percent for 12th-graders. Also within the past year, 6.5 percent of 12th-graders used sedatives/ barbiturates (e.g., Amytal, Nembutal) nonmedically, and 10.0 percent used amphetamines (e.g., Ritalin, Benzedrine).

Youth who use other drugs are more likely to abuse prescription medications. According to the 2001 National Household Survey on Drug Abuse (now the NSDUH), 63 percent of youth who had used prescription drugs nonmedically in the past year had also used marijuana in the past year, compared with 17 percent of youth who had not used prescription drugs nonmedically in the past year.

Gender differences

Studies suggest that women are more likely than men to be prescribed an abusable prescription drug, particularly narcotics and antianxiety drugs—in some cases, 55 percent more likely.

Overall, men and women have roughly similar rates of nonmedical use of prescription drugs. An exception is found among 12- to 17-year-olds. In this age group, young women are more likely than young men to use psychotherapeutic drugs nonmedically. In addition, research has shown that women are at increased risk for nonmedical use of narcotic analgesics and tranquilizers (e.g., benzodiazepines).

Treatment of Drug Addiction

The two main categories of drug addiction treatment are behavioral and pharmacological. Behavioral treatments encourage patients to stop drug use and teach them how to function without drugs, handle cravings, avoid drugs and situations that could lead to drug use, and handle a relapse should it occur. When delivered effectively, behavioral treatments-such as individual counseling, group or family counseling, contingency management, and cognitiveÐ behavioral therapiesÑalso can help patients improve their personal relationships and their ability to function at work and in the community.

Some addictions, such as opioid addiction, can be treated with medications. These pharmacological treatments counter the effects of the drug on the brain and behavior, and can be used to relieve withdrawal symptoms, treat an overdose, or help overcome drug cravings. Although a behavioral or pharmacological approach alone may be effective for treating drug addiction, research shows that, at least in the case of opioid addiction, a combination of both is most effective.

Treating addiction to prescription opioids

Several options are available for effectively treating prescription opioid addiction. These options are drawn from research regarding the treatment of heroin addiction, and include medications such as naltrexone, methadone, and buprenorphine, as well as behavioral counseling approaches.

Naltrexone is a medication that blocks the effects of opioids and is used to treat opioid overdose and addiction. Methadone is a synthetic opioid that blocks the effects of heroin and other opioids, eliminates withdrawal symptoms, and relieves drug craving. It has been used successfully for more than 30 years to treat heroin addiction. The Food and Drug Administration (FDA) approved buprenorphine in October 2002, after more than a decade of research supported by NIDA. Buprenorphine, which can be prescribed by certified physicians in an office setting, is long lasting, less likely to cause respiratory depression than other drugs, and is well tolerated. However, more research is needed to determine the effectiveness of these medications for the treatment of prescription drug abuse.

A useful precursor to long-term treatment of opioid addiction is detoxification. Detoxification in itself is not a treatment. Rather, its primary objective is to relieve withdrawal symptoms while the patient adjusts to being drug free. To be effective, detoxification must precede long-term treatment that either requires complete abstinence or incorporates a medication, such as methadone or buprenorphine, into the treatment program.

Treating addiction to CNS depressants

Patients addicted to barbiturates and benzodiazepines should not attempt to stop taking them on their own. Withdrawal symptoms from these drugs can be problematic, andÑin the case of certain CNS depressants- potentially life-threatening. Although no research regarding the treatment of barbiturate and benzodiazepine addiction exists, addicted patients should undergo medically supervised detoxification because the treatment dose must be gradually tapered. Inpatient or outpatient counseling can help the individual during this process. Cognitive behavioral therapy, which focuses on modifying the patient's thinking, expectations, and behaviors, while at the same time increasing skills for coping with various life stressors, also has been used successfully to help individuals adapt to the discontinuation of benzodiazepines.

Often barbiturate and benzodiazepine abuse occurs in conjunction with the abuse of another substance or drug, such as alcohol or cocaine. In these cases of polydrug abuse, the treatment approach must address the multiple addictions.

Treating addiction to prescription stimulants

Treatment of addiction to prescription stimulants, such as Ritalin, is often based on behavioral therapies that have proven effective in treating cocaine and methamphetamine addiction. At this time, there are no proven medications for the treatment of stimulant addiction. However, NIDA is supporting a number of studies on potential medications for treating stimulant addiction.

Depending on the patient's situation, the first steps in treating prescription stimulant addiction may be tapering the drug dosage and attempting to ease withdrawal symptoms. The detoxification process could then be followed by one of many behavioral therapies. Contingency management, for example, uses a system that enables patients to earn vouchers for drug-free urine tests. (These vouchers can be exchanged for items that promote healthy living.) Cognitive-behavioral therapy also may be an effective treatment for addressing stimulant addiction. Finally, recovery support groups may be helpful in conjunction with behavioral therapy.

Other Articles in the Prescription Drug Abuse Series

	Prescription Drug Abuse Part I Introduction Prescription Drug Abuse Part III - Texas Medical Board Rule 170

About SETMA	In The News	Syllabus PC-MH Externship	Patient Information	Presentations
Governance Board	Your Life Your Health	Public Reporting	Accreditations/Awards	Diabetes Center of Excellence
EPM Tools	Transforming Your Practice Library	Medical Home	I-CARE Initiative	NextMD