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’s Preventive Health Screenings: Colon Cancer, High Blood Pressure, Diabetes, and Hyperlipidemia

Norma Duncan,MSN, APRN-BC, FP

April 24, 2003

Your Life Your Health - The Examiner

In primary care medicine, we offer many types of health screenings. In a previous article, we spoke of pap smears, mammograms, and bone density. Today I'll explain the "when" and "why" of screening for colon cancer, hypertension, diabetes, and hyperlipidemia, which may be better known as "high cholesterol."

Colon cancer is a preventable cancer like cervical cancer. In preventive health screenings, your healthcare provider looks to find colon cancer markers before the true disease develops.

Hypertension is widely known as the "silent killer". Finding it early and treating it aggressively (which does not always mean drugs) is essential.

Diabetes is a sneaky disorder that invades every organ system in the body with devastating results. It is often not found until several years of damage have already occurred. The only way to avoid this is through preventive health screenings. As I often tell my patients with diabetes, diabetes is only a number when I diagnose, it but the danger lies in what that number (the blood sugar) is doing to their blood vessels.

High cholesterol, more appropriately known as hyperlipidemia, sends a signal to us that all may not be well in the lining of your blood vessels. This lining is the "endothelium" and it is the largest organ in your body. The endothelium is where all the action takes place in vascular disease. We can't see the lining well, even with invasive procedures, so we try to reduce the risk of endothelial problems by treating hyperlipidemia aggressively.

Colon Cancer Screening

Let's begin with colon cancer screenings. "Screening" means we are checking for something that we don't know actually exists. We do know that there are increased chances of colon cancer the older you get. We know that if you have two primary relatives (mother, father, brother, or sister) with polyps or colorectal cancer then you should have an initial screening colonoscopy by your early 20's, or ten years prior to the earliest diagnosis of a family member with the disorder, whichever comes first.

Colonoscopy

Colonoscopy is not the only diagnostic tool, but it is the most sensitive and specific screening for colon cancer. It also allows for any lesions to be sampled for biopsy and removed at the same time. Many different health care providers are skilled at performing colonoscopy but most often it will be performed by a Gastroenterologist.

What if you have no special risk or any present signs and symptoms that would indicate a problem in the colon or rectum? Then, you can expect most primary care providers to screen with stool cards at age 40. Digital rectal exams also become standard during this decade. When you become 50, your provider will talk to you about a screening colonoscopy. Unlike many expensive "screening" tests, colonoscopy has become so useful and has proved so helpful, that most legislatures have mandated that if a person requests a "screening colonoscopy" insurance carriers are obligated to provide the test for them.

When I recommend a colonoscopy for my patients they usually respond with the following question: "Are they going to knock me out for that?" The test involves using a small fiber-optic camera that is inserted through the rectum. The most important part of the procedure is proper preparation on your part. The bowel must be cleaned out so that any polyps may be seen and removed. If you don't participate in this part as the doctor asks, then you won't get the full advantage of this powerful preventive procedure. So listen carefully and do the prep well.

Will they "knock you out" for the colonoscopy? No, you are not "out" for this. The Gastroenterologist will use what we call "conscious sedation" which means you will be alert enough to respond but you will be very relaxed. Most of the time the doctor uses a drug that induces amnesia about the procedure. This means that not only do you not feel in pain, you will not remember the procedure.

Blood Pressure

Blood pressure should be measured at every office visit. Those office visits should increase in frequency as you age. Most pediatricians will begin to measure blood pressure by at least the age of five. There are some notable changes in our consideration of what is acceptable blood pressure.

For most of us a blood pressure of 140/90 or more is considered high. A single reading does not diagnose it. Your doctor may ask you to keep a blood pressure diary. If the only time the blood pressure is up is when you are in our office then we may ask you to wear an ambulatory blood pressure monitor. We look at trends, not a single reading. However, if you visit me and I find a pressure of 180/110 or something similar, be assured we will begin treatment on the spot, even with this singular but dangerous reading.

Elderly patients used to find us accepting high "top" number readings. That is no longer the case. Research has shown us that we must control the "top number" or "systolic" reading to protect them from stroke and heart attacks. My target blood pressure for most of the people I care for is 130/80, when they're happy, when they're sad, when life is good, when life is bad?130/80.

Most of the hypertensive patients I care for have other risk factors. Getting to this number is especially important in those with diabetes and known cardiovascular disease. Anyone with a diagnosis of diabetes is now expected to already have cardiovascular disease.

Diabetes Screening

Blood sugars should be measured every five years in a person with no risk factors. You will find me sticking your finger for a blood sugar if you have had large babies (mostly > 9 lbs), have a lot of abdominal fat, or repeat skin infections. If you were diagnosed with gestational diabetes (diabetes during pregnancy) I may stick your finger every time I see you. I will try to get a fasting blood sugar.

If your blood sugar is high (close to 100) I will ask you to allow me to stick your finger 2 hours after a high carbohydrate meal. Our instructions in this are "Go to (insert fast food restaurant) and knock yourself out eating lots of carbs!" We check your blood sugar 2 hours after the meal to see if your body can handle the sugar load. This technique can "bring out the worst" and allow us to diagnose and treat diabetes early. Early treatment revolves around lifestyle modification which is code for eating properly and exercising vigorously daily.

Cholesterol Screening

Hyperlipidemia means high blood fats. These high readings along with hypertension and high blood sugars can wreck the lining of your blood vessels making plaques (yes you have them) unstable which may mean a heart attack or stroke may be in the offing. With minimal or no risk factors, I will usually get a lipid profile sometime in your twenties.

With a primary family history of early death from heart attack or stroke, I will do them earlier and more frequently.

An obese child will often get their lipid profile along with a fasting blood sugar measurement.

In your thirties, we will usually measure the lipids every five years if you have no risk factors that would dictate more frequent readings.

To get accurate lipid measurements you must be fasting at least 10-12 hours. Fasting means that you have no calories during this time. It does not mean that you skip medications and you can drink water or black coffee. I have many elderly people who come in dehydrated with high blood pressure because they withhold water and medications when they fast for lipid and blood sugar testing. Fasting for lab is different than fasting for a surgical procedure. We are only asking for some blood for labwork, so drink water and take your medications as prescribed.

Cholesterol - Four Numbers and What They Mean

When you receive your readings from the lipid profile you will commonly get four numbers.

The first one usually listed is serum cholesterol, which is the general amount of cholesterol. We want it less than 200 generally. However, we are much more interested in the next three readings. These are the specific kinds of lipids.

The first one would be the HDL. It is highly desirable, it is the happy cholesterol, and you are happy if it's high. This is my way of teaching the patient that this lipid is protective of your blood vessels.

The next component is the low-down, bad boy, least desirable cholesterol known as the LDL. Generally speaking we want it low because it messes with the lining of the blood vessels, the endothelium, making the plaques unstable and inflamed. We will aim for the lowest LDL in patients with known coronary disease and diabetes.

The next component is the triglycerides. These are the building blocks of the LDL. Many times they herald the coming of diabetes or low thyroid functioning. Triglycerides are also the most sensitive to a bad diet. This is a diet with lots of sugar and white flour. Triglycerides may also be high with a high alcohol intake.

This information is given to countless patients by countless doctors and nurse practitioners like me every day. Preventing disease or detecting it before it can do damage is what we like best. However, we have to see you to do this effectively. Make that appointment for a "well visit" today.

Remember it is your life and 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