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 - Alcohol in health and in hearth

James L. Holly,M.D.

November 19, 2009

Your Life Your Health - The Examiner

When my oldest granddaughter was young she could not say an "m" after an "s" and would always substitute an "n." She often said, "You're not every 'snart' if you 'snoke." I tell that to my patients and they laugh, whereupon I say, "Now, do you really think it is funny when someone tells you that you're stupid?" Fortunately, today there is a social stigma to smoking which has helped many people quit who would not otherwise have done do so. Sadly, that stigma is not as great today as it was a few years ago and, to the delight of the tobacco companies, there is a rise in the incidence of smoking among young people.

Sadly, there is not such a stigma in regard to alcohol consumption. Recently, I had occasion to tell my wife, "Even if I did not have personal religious convictions about avoiding alcohol, I would not drink because of the health implications of beverage alcohol." I am personally shocked at how integral alcohol consumption is to social interactions in the United States. It is beyond my comprehension why people think that an opportunity to "get together" most often means an opportunity to drink alcohol at all and most often to drink it in excess. And, before you say, "I don't drink in excess," read on." Furthermore, it amazes me that healthcare professionals regularly drink alcohol in excess without any negative social implications. In fact, most often, the negative social impact is upon those who choose not to drink rather than those who drink excessively.

How do you measure alcohol consumption?

In a major study, published by the World Health Organization in 2004, entitled, "Global Report on Alcohol," the following definitions of alcohol-drinking categories were identified:

Category I: for females not exceeding on average 0 to 19.99 grams pure alcohol per day; for males not exceeding on average 0 to 39.99 grams pure alcohol per day;
Category II: for females not exceeding on average 20 to 39.99 g pure alcohol per day; for males not exceeding on average 40 to 59.99 grams pure alcohol per day;
Category III: for females on average 40 grams pure alcohol and above per day; for males on average 60 grams pure alcohol and above per day.

But, you ask, "How much alcohol is a 'gram'?"

A standard drink in the United States is equal to 13.7 grams (0.6 ounces) of pure alcohol or

12-ounces of beer.
8-ounces of malt liquor.
5-ounces of wine.
1.5-ounces or a "shot" of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey).

Often, when taking a history, patients will say, "I don't drink hard liquor; I only drink beer." They say this thinking that drinking beer is safe. Is beer or wine safer to drink than liquor? The reality, as seen above, is that one 12-ounce beer has about the same amount of alcohol as one 5-ounce glass of wine, or 1.5-ounce shot of liquor. It is the amount of ethanol consumed that affects a person most, not the type of alcoholic drink.

What does moderate drinking mean?

There is no one definition of moderate drinking, but generally the term is used to describe a lower risk pattern of drinking. According to the Dietary Guidelines for Americans, drinking in moderation is defined as having no more than 1 drink per day for women and no more than 2 drinks per day for men. This definition is referring to the amount consumed on any single day and is not intended as an average over several days.

The truth is that you cannot "save up" your daily allotment of alcohol consumption and then consume it in one day and pretend that you are not an excessive drinker and/or avoid the health consequences of excessive alcohol consumption. If you exceed the "moderate drinking level on any one day a week, you will reap the health consequences of excessive drinking.

All of the research on "protective" benefits of alcohol relate to a regular consumption of one alcoholic drinking every other day and also seems to indicate that any health benefit of alcohol consumption at this low level is predominantly found when alcohol is consumed with a meal.

Does alcohol consumption above the one drink every other day with meals and particularly excessive drinking even one day a week contribute to illness?

Alcohol affects every organ in the body. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. Alcohol is metabolized in the liver by enzymes; however, the liver can only metabolize a small amount of alcohol at a time (less than one ounce of alcohol a day), leaving the excess alcohol to circulate throughout the body. The intensity of the effect of alcohol on the body is directly related to the amount consumed.

Over 60 serious, life-threatening, and life-shortening illnesses are caused by or worsened by alcohol consumption. There has never been a study which suggests that the potential health benefit of alcohol consumption outweighs the potential risk of excessive alcohol use. A number of disease conditions are wholly attributable to alcohol. These include:

alcoholic psychoses
alcohol-dependence syndrome
alcoholic polyneuropathy
alcoholic cardiomyopathy
alcoholic gastritis
alcoholic liver cirrhosis

Alcohol can cause a number of different cancers:

The risks of developing lip, tongue, throat, oesophagus and liver cancer increases proportionally with the amount of alcohol consumed.
Even moderate alcohol consumption can cause breast cancer, according to recent research, and a series of studies confirm that the risk increases with the amount consumed.
Evidence of a possible link with alcohol consumption is weaker for cancers of the stomach, prostate, colon, rectum and ovaries

Alcohol consumption, particularly heavy drinking occasions, can contribute to high blood pressure, abnormal heart rhythms, heart failure, and strokes. At low levels of consumption (less than 40g of pure alcohol per day) without heavy drinking occasions alcohol may protect against strokes, at least in women. This is equivalent to 3 small glasses of wine or 1 litre of beer per day. Above this limit, the risks of cardiovascular disease increase dramatically.

Alcohol is the main cause of liver cirrhosis in developed countries. However, in China and India, for instance, liver cirrhosis is mainly caused by other factors such as viral infections. The fraction of liver cirrhosis attributable to alcohol ranges from as low as 10% in China, up to 90% in Finland. It is very difficult to determine whether an individual's cirrhosis is induced by alcohol or by other unspecified causes, and a considerable proportion of deaths from cirrhosis in which alcohol is not mentioned may in fact be attributable to alcohol. Apparently the risk of liver cirrhosis mainly depends on the volume of alcohol consumed, but possibly also on heavy drinking occasions.

Alcohol appears to contribute to causing depression. Moreover, alcohol dependence and other mental conditions often go hand in hand, though the role of alcohol in these conditions remains unclear.

Who should not drink alcohol?

The current Dietary Guidelines for Americans specify that there are some people who should not drink alcoholic beverages at all, including

Children and adolescents.
Individuals of any age who cannot limit their drinking to low levels.
Women who may become pregnant or who are pregnant.
Individuals who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination.
Individuals taking prescription or over-the-counter medications that can interact with alcohol.
Individuals with certain medical conditions.
Persons recovering from alcoholism.

Is teenage or pre-teen drinking safe and legal?

Studies have shown that alcohol use by youth and young adults increases the risk of both fatal and nonfatal injuries. Research has also shown that youth who use alcohol before age 15 are five times more likely to become alcohol dependent than adults who begin drinking at age 21. Other consequences of youth alcohol use include increased risky sexual behaviors, poor school performance, and increased risk of suicide and homicide.

Sadly, in the State of Texas it is not illegal for parents to serve alcohol to their pre-teen and teenage children. The conditions are, however, that the parents must give the alcohol to the child AND the parent must be in the room, in the presence of the child while they are drinking. It is criminal for any adult to give alcohol to any children not his/her own.

Teenage alcohol use would be decreased significantly if parents who facilitate the drinking of alcohol by children other than their own were to be prosecuted to the fullest extent of the law and were given the harshest sentences possible under the law. Also, teen drinking would be significantly decreased if adults who facilitate children drinking were prosecuted and sentenced for negligent homicide, injury to a child and other applicable crimes when a child is killed or injured in an automobile accident caused by illegal alcohol by a minor.

Parents would do well NOT to allow their children to be supervised by other adults who have not formally given them assurances that they know, respect and intend to obey the laws concerning teenage drinking both in avoiding the active giving of alcohol to their children and/or to negligent allowing of alcohol to be obtained in their homes or while the child is in their care. Remember, it is illegal to allow a child under 21 to obtain alcohol. This crime is rarely reported and rarely punished which is a fact of shame for parents who avow to love and protect their children.

Conclusion

It is sad that there is no social stigma to the consumption of beverage alcohol in the United States of America. It is sad that many who believe they are "social drinkers" or really beige and/or heavy drinkers. It is sad that many people don't believe that beer is alcohol. There was a time when one was considered stylish or sophisticated to have a cigarette in hand or mouth. To a great deal that is now considered not to be "snart." Now, it is considered stylish or sophisticated to have a "drink" - not a cold drink or juice - but an alcoholic beverage in your hand. That is sad.

It is a greater shame that few people are prosecuted for providing alcohol to teenagers who are not their own children. You cannot say that you love your child and provide them the tool (beverage alcohol) for the destruction of their mind and/or body. How sad it was when I was told that in Pakistan, in order to buy alcohol you must prove that you are a Christian, as alcohol will not be sold to a Muslim.

If you don't want to have cancer, cirrhosis, heart disease, hypertension, depression or 60 other diseases, don't drink. Next time you give a party, see if your friends will come if you don't serve them alcohol. See how many will appreciate that you care about their health by not encouraging them or facilitating them not to destroy their health while "having a good time."

Remember, it is your life and it is your health. It is your responsibility to care for your health and not to harm the health of those you love.

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