The Leadership Style of "The People's Doctor": A Contemporary Look Back at New York State Commissioner of Health David Axelrod, MD.

David Axelrod, MD, New York State's commissioner of health from 1979 to 1991, had a panoramic view of public health and a legendary track record of tackling complex issues ranging from the Love Canal environmental disaster to HIV/AIDS and end-of-life ethics. Many raved about Axelrod's leadership, whereas others criticized his response and style. Two decades later, we describe his leadership attributes. Our retrospective review incorporates interviews with former staff and coworkers and information from historical archives. Axelrod's leadership style mirrored that of business leaders, goal driven and focused on execution, as opposed to the typical style of public health leaders, more sympathetic to needs of the team. He framed his mission within the context of social justice and data-driven science. His story, one in which leadership inspired passion and loyalty to science, is driven by a laser-sharp focus on the public good. In today's resource-deprived, politically charged environment, Axelrod's methods for achieving positive community health outcomes warrant close scrutiny. (Am J Public Health. 2019;109:85-91. doi:10.2105/AJPH.2018.304710).

Health care savings with the patient-centered medical home: Community Care of North Carolina's experience.

This study evaluated the financial impact of integrating a systemic care management intervention program (Community Care of North Carolina) with person-centered medical homes throughout North Carolina for non-elderly Medicaid recipients with disabilities during almost 5 years of program history. It examined Medicaid claims for 169,676 non-elderly Medicaid recipients with disabilities from January 2007 through third quarter 2011. Two models were used to estimate the program's impact on cost, within each year. The first employed a mixed model comparing member experiences in enrolled versus unenrolled months, accounting for regional differences as fixed effects and within physician group experience as random effects. The second was a pre-post, intervention/comparison group, difference-in-differences mixed model, which directly matched cohort samples of enrolled and unenrolled members on strata of preenrollment pharmacy use, race, age, year, months in pre-post periods, health status, and behavioral health history. The study team found significant cost avoidance associated with program enrollment for the non-elderly disabled population after the first years, savings that increased with length of time in the program. The impact of the program was greater in persons with multiple chronic disease conditions. By providing targeted care management interventions, aligned with person-centered medical homes, the Community Care of North Carolina program achieved significant savings for a high-risk population in the North Carolina Medicaid program.

Quality of care measurement in nursing home AIDS care: a pilot study.

A pilot study was conducted to identify which, if any, demographic or quality indicators differentiate HIV-positive patients from other long-term care patients. This study used the Minimum Data Set files for all New York state nursing homes submitted in 1997. Chi-square tests were used to assess difference in proportions of demographics and quality indicators between HIV-positive and HIV-negative patients. The HIV-positive patients tended to be between 40 and 59 years of age and male and were more likely to be Black or Hispanic. HIV-positive patients had a significantly higher prevalence of diagnosis or symptoms of depression without any treatment compared to HIV-negative patients. HIV-positive patients had significantly higher prevalence of weight loss, antipsychotic use, antianxiety/hypnotic use, and incontinence of bladder and bowel compared to HIV-negative patients. This study paves the way for the development of a more appropriate quality indicator system tailored to the AIDS population and allows facilities to make necessary improvements in the quality of care offered to this vulnerable population.