Quality of care; Long-term care; Risk-adjusted outcomes; Racial disparities; Health economics; Quality report cards
2015 Lifetime Achievement Award, American Public Health Association
2014 Winner of the “Research Associates Athalie Clarke Achievement Award” for senior faculty member whose research has made significant advances in medicine or basic science.
1997 James G. Zimmer New Investigator Award for Excellence in Research in Aging and Disability, American Public Health Association, Gerontological Health Section.
Dana B. Mukamel, Ph.D. is Professor at the Department of Medicine and Director of the iTEQC Research Program at the University of California, Irvine (UCI). She also holds appointments in Public Health and Nursing. Prior to joining the University of California she was on the faculty at the University of Rochester Medical Center. She also has affiliations with the UCI Paul Merage School of Business and the program in Public Health at UCI.
Dr. Mukamel holds an M.S. in Technology and Policy from MIT and a Ph.D. in Economics from the University of Rochester Her research focuses on issues related to quality of care in acute and long term care settings, both methodological issues related to measurement of quality and empirical studies designed to offer insights into policy, market, and provider characteristics that contribute to provision of high quality care. She has developed methods to measure quality in nursing homes and community based long term care programs based on risk-adjusted health outcomes, such as risk-adjusted decline in functional status and pressure ulcers. Her studies have examined the role of competition, regulation, report cards and other factors in provision of high quality care. Her extensive research program is funded by grants from federal agencies (AHRQ, NIA, NINR and the VA), PCORI, and private foundations. Recently, she expanded her work to include the development of sophisticated decision aids, taking advantage of big data and preference elicitation techniques to enhance the capabilities of patients, providers, and policy makers to make better decisions consistent with individual medical needs and preferences.
Dr. Mukamel serves on several CMS task forces advising CMS on the design of risk-adjusted quality measures, quality report cards, and pay for performance programs. Dr. Mukamel has served on the editorial board of the American Journal of Public health and as an editor of the Journal of Health Services Research Outcomes and Methodology. She currently serves on the editorial board of the Journal of Health Services Research. She also serves on many national advisory and review boards for organizations such as CMS, NIH, AHRQ, VA and MedPAC. Dr. Mukamel received a Lifetime Achievement Award from the American Public Health Association (APHA) for her work on quality of long term care.
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CONTRIBUTIONS TO SCIENCE with selected PUBLICATIONS and are listed below:
1. Development of Risk Adjusted Outcome Measures of Quality: Health care report cards have become a mainstay of our healthcare system. There are over 150 public report cards, including the Care Compare series published by the Federal Government. More have been published following the mandates of the Affordable Care Act of 2010. All of these rely on risk adjusted outcomes-based quality measures. My 1997 Medical Care paper was the first study to develop such measures for nursing homes, paving the way to the first Federal report card – Nursing Home Compare. Following this work, I continued to investigate the methodological issues related to the measurement of quality using these methods, to study the properties of these measures, and to develop new prototype measures in other areas, such as end-of-life care. I serve on many advisory boards for CMS, as well as private organizations, that are charged with development of these types of quality measures.
Selected citations include:
a. Mukamel DB. "Risk Adjusted Outcome Measures and Quality of Care in Nursing Homes." Medical Care 1997; 35(4):367-385.
b. Spector WD, Mukamel DB. "Using Outcomes to Make Inferences about Nursing Home Quality." Evaluation and the Health Professions 1998; 21(3):291-315
c. Mukamel DB, Dick A, Spector WD. “Specification Issues in Measurement of Quality of Medical Care Using Risk Adjusted Outcomes”, Journal of Economic and Social Measurement 2000; 26(3,4):267-282.
d. Mukamel DB, Glance LG, Li Y, Weimer DL, Spector WD, Zinn JS, Mosqueda L. “Does Risk Adjustment of the CMS Quality Measures for Nursing Homes Matter?” Medical Care 2008 May; 46(5):532-541. PMCID: PMC2741305
e. Weimer DL, Saliba D, Ladd H, Shi Y, Mukamel DB. “Using Contingent Valuation to Develop Consumer-Based Weights for Health Quality Report Cards” Health Services Research 2019 Aug; 54(4):947-956. DOI: 10.1111/1475-6773.13155. Epub 2019 Apr 22. PMCID: PMC6606546 [Available on 08-01-2020].
2. Studies of Quality Report Cards: Competition in health care markets requires that consumers be informed about both costs and quality. Recognizing this imperative, the U.S. has begun in the late 1980s to develop and publish public quality report cards. Understanding the impact of report cards on patients, providers, and quality of care has become a major area of study, informing important policy developments. I was the first to study the impact of quality report cards on patients, physician prices, managed care contracting practices and racial disparities. Over the last two decades, I have examined many facets of the use of report cards, including their effect on quality relative to quality regulation. I have contributed to the development of many of the CMS report cards through my work on various advisory boards, and in particular the Nursing Home Care Compare report card and the development of the 5 Star system.
Selected citations include:
a. Mukamel DB, Mushlin AI. "Quality of Care Information Makes a Difference: An Analysis of Market Share and Price Changes Following Publication of the New York State Cardiac Surgery Reports." Medical Care 1998; 36(7):945-954.
b. Mukamel DB, Weimer DL, Haeder S. “Top-Down and Bottom-Up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards – A Review.” Annual Review of Public Health (Invited Review) 2014 Mar 18; 35: 477-97. doi: 10.1146/annurev-publhealth-082313-115826. Epub 2013 Oct 23.
c. Mukamel DB, Glance LG, Dick AW, Osler TM. “Measuring Quality for Public Reporting of Health Provider Quality: Making It Meaningful to Patients” American Journal of Public Health 2010 Feb; 100(2):264-9. PMCID: PMC2804637
d. Mukamel DB, Weimer DL, Zwanziger J, Mushlin AI, Huang-Gorthy SF. “Quality Report Cards, Selection of Cardiac Surgeons and Racial Disparities: A Study of the Publication of the NYS Cardiac Surgery Reports.” Inquiry 2004/2005; 41(4):435-446.
e. Mukamel DB, Weimer DL, Mushlin AI. “Interpreting Market Share Changes as Evidence for Effectiveness of Quality Report Cards”. Medical Care 2007; 45(12):1227-1232.
f. Mukamel DB, Weimer DL, Spector WD, Ladd H, Zinn JS. “Publication of Quality Report Cards and Trends in Reported Quality Measures in Nursing Homes”, Health Services Research 2008; 43(4):1244-1262. PMCID: PMC2517273
3. Racial Disparities: Racial disparities in the American health care system are both pervasive and persistent. Healthy People goals in both 2010 and 2020 focused on addressing disparities and the department of Health and Human Services has been directed by Congress to address disparities in all its programs and policies. Much of the literature and the knowledge base relating to this topic has historically been focused on documenting the problem as distinct from trying to identify its causes. My studies have focused on contributing to the understanding of the processes that lead to disparities. For example, my studies have shown that the disparity that African Americans experience in accessing low quality cardiac surgeons is attributable to both their referral networks, which are of lower quality and to differential treatment by referring physicians. This study has also been able to identify factors influencing the differential treatment by referring physicians.
Selected citations include:
a. Mukamel DB, Weimer DL, Mushlin AI. “Referrals to High Quality Cardiac Surgeons: Patient Race and Characteristics of their Physicians” Health Services Research 2006; 41(4 pt 1), 1276-1295. PMCID: PMC1797085.
b. Mukamel DB, Glance LG, Weimer DL, Pearson T, Massey T, Gold J, Greenfield S, Jackson J, Mushlin AI. “Racial Variations in the Choice of On-Pump versus Off-Pump CABG Surgery”. Journal of Health Services Research and Policy 2007; 12(1):31-35.
c. Rothenberg BM, Pearson T, Zwanziger J, Mukamel DB. “Explaining Disparities in Access to High Quality Cardiac Surgeons.” Annals of Thoracic Surgery 2004; 78(1):18-24.
d. Li Y, Yin J, Cai X, Temkin-Greener H, Mukamel DB. “Association of Race and Sites of Care with Pressure Ulcers in High-Risk Nursing Home Residents” Journal of the American Medical Association 2011 Jul 13; 306(2):179-186. PMCID: PMC4108174.
4. Quality and Costs of Long-Term Care: Long-term care is becoming increasingly more important as the population ages and more individuals require services, either in the community or in nursing homes. The quality of these services has long been a concern, partly because many of these services are paid for by public payers, Medicare and Medicaid. My studies have contributed to the understanding of the processes and mechanisms that lead to better care. In addition to studies of the impact of report cards, described above, I studied regulation of quality, the impact of teams, quality of end-of-life care, racial disparities and quality, and costs and quality.
Selected citations include:
a. Mukamel DB, Cai S, Temkin-Greener H. “Cost Implications of Organizing Nursing Home Workforce in Teams” Health Services Research 2009 Aug; 44(4):1309-25. PMCID: PMC2739030.
b. Temkin-Greener H, Bajorska A, Mukamel DB. “Variations in Service Use in the Program of All-Inclusive Care for the Elderly (PACE): Is More Better?” The Journal of Gerontology: Medical Sciences 2008; 63A(7): 731-738.
c. Mukamel DB, Caprio T, Ahn R, Zheng NT, Norton S, Quill T, Temkin-Greener H. “End-of-Life Quality of Care Measures for Nursing Homes: Place of Death and Hospice” Journal of Palliative Medicine 2012 Apr; 15(4):438-46. PMCID: PMC3322517.
d. Mukamel DB, Weimer DL, Harrington C, Spector WD, Ladd H, Li Y. “The Effect of State Regulatory Stringency on Nursing Home Quality” Health Services Research 2012 Oct; 47(5):1791-813. PMCID: PMC3513606. Best in ARM 2012.
e. Mukamel DB, Li Y, Weimer DL, Spector WD, Bailey L, Harrington C. “What Factors Contribute to Successful Appeal of Nursing Homes’ Deficiencies in the Informal Dispute Resolution Process?” Journal of the American Medical Directors Association 2013, Feb; 14(2):101-4. PMCID: PMC3563759.
f. Mukamel DB, Fortinsky RH, White A, Harrington C, White, LM. “The Policy Implications of the Cost Structure of Home Health Agencies”, Medicare and Medicaid Research Review 2014, 4(1):E1-
R21 HS021844 Patient Centered Quality Reporting: NHCPlus. Agency for Healthcare Research and Quality (AHRQ). PI: Dana Mukamel, 09/01/12 – 08/31/16. Total Costs: $998,231.
73053 Understanding Consumers’ Health Care Preferences and Values. Robert Wood Johnson Foundation (RWJF). PI: Dana Mukamel, 10/01/15 – 12/31/17. Total Costs: $400,000.
R01 AG049705 Improving Quality Report Cards through Inclusion of Consumers Preferences, NIA. PI: Dana Mukamel. Project Dates: 09/30/16 – 10/31/20. Total Costs: $1,502,874.
R01 AG051719 The Costs of Home Health and Patient Outcomes, NIA. PI: Dana Mukamel. Project Dates: 09/01/16 – 05/31/22. Total Costs: $2,145,418.
R01 AG066742 Staffing and Health Outcomes in Nursing Homes for Residents with and without Dementia, NIH. PI: Dana Mukamel, 06/01/20 – 05/31/25. Total Costs: $3,149,597.