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 - Women and Heart Disease Prevention

James L. Holly,M.D.

March 31, 2005

Your Life Your Health - The Examiner

If you ask women what health issue they worry the most about, breast cancer would be at the top of the list. Yet, 500,000 women die annually from coronary artery disease (CAD), which exceeds the number of deaths in men from the same condition. The number of women who die of heart disease each year exceeds the number of deaths in women from all cancers combined, and for every one woman who dies of breast cancer, twelve die of heart disease. Four out of five of 5 women are unaware that heart disease is their greatest health threat.

The reality is that a great deal can be done to prevent and/or to treat heart disease in woman. The major, modifiable risk factors for heart disease in woman are:

Hypertension
Diabetes
Abnormal cholesterol
Smoking
Sedentary Life Style
Inflammation

Hypertension

The prevalence of high blood pressure, defined as a systolic pressure above 140 and/or a diastolic pressure above 90, increases in woman with age. By age 60, systolic blood pressures are greater in women than in men. Over 75 years of age, 80% of women are hypertensive.

The association between hypertension and CAD in women is clear and women with hypertension have four times the relative risk of myocardial infarction. Women with hypertension have seven times the risk of fatal coronary events.

Decreasing the blood pressure has proven effective in lowering cardiovascular disease (CHD) risk. Modest reductions due to the following can have a significant effect on reducing cardiovascular disease risk:

increasing physical activity
reducing weight
decreasing alcohol intake
decreasing sodium (salt) intake.

Women often have inadequate blood pressure control. In one study, 71% of women over 70 had inadequate blood pressure control in one study.

Diabetes

Diabetes is a major risk factor for CHD, in fact, diabetes is called a "risk equivalent" because it ranks with high blood pressure and elevated cholesterol as major risks for CHD. The increased risk for CHD associated with diabetes is greater for women than for diabetic men. And, diabetic women are more likely to die after an MI than men. Women with diabetes also have higher rates of other CHD risk factors, such as:

Hypertension
High cholesterol
Obesity
Sedentary life style

However, even eliminating these factors, women still have an increased risk of CHD mortality compared with diabetic men. There is increasing evidence of a continuous linear relationship between blood glucose levels and macrovascular disease such as CAD. This means that the higher the average blood sugar in a diabetic patient, the greater the risk of heart disease becomes.

In January, 2004, the American Diabetic Association set treatment goals for diabetics of 7% HgbA1c and 130/80 blood pressure. In diabetic woman, given the excess mortality compared with diabetic men, these guidelines may be inadequate.

Cholesterol

The Framingham study and others have clearly established the association between hyperlipidemia (elevated cholesterol) and CHD risk. At hour next office visit, ask your doctor to calculate your Framingham Risk Score. If it is above 20%, you are at high risk of heart disease; if it is between 10% and 20%, you are at intermediate risk.

Yet, even here there is a difference in the risk between men and women. Cholesterol levels change differently for men and women:

Under the age of 20, cholesterol levels are comparable between men and women.
From 20-55, men have on average higher total cholesterol values.
After age 55, cholesterol values in women rise, with an increase in both total and LDL cholesterol (the bad cholesterol).

HDL levels (the good cholesterol) decrease slightly after menopause but throughout their lifetime, women have on average higher HDL than men. The LDL seems to a less potent risk factor for CHD in women compared with men. This is especially true for women over 65. For women age 65 and older, an LDL value 160 mg/dl or higher increased risk by 1.13 for a CHD event compared with women with an LDL less than 140 mg/dl. For women younger than 65, an LDL of 160 mg/dl or greater has a risk 3.27 compared with LDL values less than 140.

Women older than 71 with an HDL above 60 mg/dl had half the risk of CHD compared with women with HDL cholesterol lower than 35 mg/dl. For women over 65, HDL is the only significant lipid predictor for CHD.

Secondary prevention studies have shown risk reduction with cholesterol treatment for men and women. For women with above average risk for CAD, aggressive management of high cholesterol levels I necessary for CHD risk reduction

Smoking

Cigarette smoking has been linked to CHD in women since 1976. Women who smoke more than 34 cigarettes a day have a sevenfold increased risk of coronary events. Smoking has been linked to an increased risk of fatal and nonfatal MI. Yet, Men have higher quit rates than women smokers. Some of the reasons why men quit smoking more than men are:

Women are less likely to associate smoking with negative health risks.
Although lung cancer surpasses breast cancer as the number one cancer killer of women, women sill fear breast cancer as their greatest health risk and are less likely to fear heart disease.

Women have a harder time quitting.

Women use smoking as a coping mechanism Women use smoking as a coping mechanism
Nicotine results in a state of euphoria and an increased state of alertness that may enhance psychological addition.

Obesity

Obesity is associated with the CHD risk factors of:

Diabetes
Hypertension
High cholesterol

Women with a body mass index off 32 or greater have a relative risk of 4.1 versus those with woman with a BMI less than 19. Weight reduction alone may not improve CHD risk but it does improve:

Glucose control
Blood pressure
Lipid profiles

Exercise

The beneficial results of exercise on CHD risk have been proved. Walking briskly or exercising vigorous for at least 2.5 hours per week confers a 30% risk reduction in cardiovascular events. Prolonged sitting was associated with a significantly increase in cardiovascular risk.

Aspirin

Aspirin irreversibly inhibits platelet aggregation platelets sticking together which is the first step of a blood clot which often triggers a heart attack. However, the role of aspirin in women is less clear as the decreased risk of CHD in women on aspirin is not significant. Yet, the benefits of aspirin increases with increasing cardiovascular risk. The use of aspirin for the primary prophylaxis of CHD should be initiated:

For patients with a Framingham 10-year risk score of 15% or greater who do not have contraindications to its use.
For patients with a Framingham 10 year risk score of 6% or less, they should not receive aspirin.
For patients with a Framingham risk score 7%-14% should be considered on an individual basis.

Conclusion

CHD mortality rates have been declining for the past few decades, this decline ahs been greater for men than for women. Given that CHD increases with age and that women over 75 make up the fastest growing portion of the population, strategies to prevent CD are paramount to the health of women.

Modifiable risk factors for heart disease include:

Control of hypertension
Control or prevention of diabetes
Cessation of smoking
Prevention f weight gain
Increase of physical activity

For women at above-average risk for heart disease aggressive management of cholesterol and the use of low-dose aspirin are likely to be beneficial for CHD risk reduction.

You can change your cardiovascular risk. Your health care provider can help you, but ultimately, it is your life and it is your health.

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