Dana B. Mukamel

picture of Dana B. Mukamel

Professor of Medicine, Public Health and Nursing

Director, iTEQC Research Program


Ph.D., University of Rochester, 1993, Health Economics

Phone: (949) 824-8873
Email: dmukamel@uci.edu

University of California, Irvine
Department of Medicine
Division of General Internal Medicine
100 Theory, Suite 120
Mail Code: 3056
Irvine, CA 92617
Research Interests
Quality of care; Long-term care; Risk-adjusted outcomes; Racial disparities; Health economics; Quality report cards
URL
Academic Distinctions
2017 Best Abstract ARM 2017 – “Impact of Nursing Home Palliative Care Teams on End-of-Life Outcomes: A Randomized Controlled Trial”, Dana B. Mukamel et.al. Abstract selected as “The Most Outstanding Research submitted for Presentation in the Call for Paper Themes” at the 2017 AcademyHealth Annual Research Meeting.

2017 Winner of the “Department of Medicine Chair’s Research Award” for the proposal “Patient Decision Making in an Era of Unlimited Information and Misinformation on the Internet (UCI).” Co-PI: Dana Mukamel

2016 “Best in ARM 2016” – paper published as “Best of the 2016 AcademyHealth Annual Research Meeting” by HSR: “Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes”, Dana B. Mukamel et.al.

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.

2014 Winner of “Outstanding Research Poster Award” awarded by the American Academy of Behavior for abstract entitled “Are Disabled Older Adults Living in More Cohesive Communities More Likely to Receive Help with Mobility Needs?”, Nguyen AL and Mukamel DB.

2012 “Best in ARM 2012” – paper published as “Best of the 2012 AcademyHealth Annual Research Meeting” by HSR: “The Effect of State Regulatory Stringency on Nursing Home Quality”, Dana B. Mukamel et.al.

2011 Winner of the Aging and Public Health - Rural and Environment Award awarded by American Public Health Association for manuscript entitled “Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors” Temkin-Greener, Helena; Zheng, Tracy N and Mukamel, Dana B.

2011 Doctoral student Jingping Xing received Honorable Mention on her manuscript entitled “Factors Associated with in-Hospital Deaths among Nursing Home Residents Receiving Post-Acute Care” – Laurence G. Branch Doctoral Student Research Award funded by the Retirement Research Foundation, American Public Health Association.

2010 Winner of the Betty J. Cleckley Minority Issues Research Award awarded by the Gerontological Health Section of the American Public Health Association for manuscript entitled “Racial Disparities in In-Hospital Death and Hospice use Among Nursing Home Residents” Zheng NT; Mukamel DB; Cai S; Temkin-Greener H.

2009 Winner of the Betty J. Cleckley Minority Issues Research Award awarded by the Gerontological Health Section of the American Public Health Association for manuscript entitled “Pressure ulcer prevalence among Black and White nursing home residents in NY: Evidence of racial disparity” Cai S, Mukamel DB, Temkin-Greener H.

2009 AcademyHealth annual meeting – abstract on “Impact of Work Environment and Processes on Risk of Pressure Ulcers in NYS Nursing Homes” Temkin-Greener H, Cai S, Zheng N, Zhao H, Mukamel DB., was chosen most outstanding abstract.

2007 Aetna Susan B. Anthony Award for “Excellence in Research on Older Women and Public Health” awarded by the Gerontological Health Section of the American Public Health Association for manuscript entitled “Urinary Incontinence in Community-Living Older Women: Does Socioeconomic Status Affect Help Seeking and Receiving Treatment” Yue Li, PhD, MS, Xueya Cai, MA, Laurent Glance, MD, Dana B. Mukamel, PhD.

2007 AcademyHealth annual meeting – abstract on “Gender Differences in Healthcare-Seeking for Urinary Incontinence and the Impact of Socioeconomic Status: A Study of the Medicare Managed Care Population” Li Y, Glance LG, Mukamel DB, was chosen as one of the most outstanding research submitted to the meeting.

2006 AcademyHealth annual meeting – abstract on “When racial disparities disappear: Is it a good news story?” was chosen as one of the most outstanding research submitted to the meeting.

2006 National Institute for Health Care Management and Research & Education Foundation, Health Care Research Award – Finalist.

2004 Doctoral student, Yue Li, received the Student Award from the Medical Care Section of the American Public Health Association for “Misspecification Issues in Risk Adjustment and Constructing Outcome-Based Quality Indicators”,
Yue Li, Andrew Dick, PhD, Dana B. Mukamel.

2002 Academy for Health Services Research and Health Policy Annual Meeting, Best abstract for theme: Disparities in Health & Health Care, “Disparities in Access to High Quality Cardiac Surgeons: Race, Income, and Hospital Effects” – most outstanding abstracts.

2001 Academy for Health Services Research and Health Policy Annual Meeting: Abstract entitled “End of Life Care in Managed Care: Place of Death in the PACE Program” – most outstanding abstracts.

1997 James G. Zimmer New Investigator Award for Excellence in Research in Aging and Disability, American Public Health Association, Gerontological Health Section.

1993 David W. Stewart Assistant Professor of Health Policy
Research Abstract
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). 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 and a Ph.D. in economics. 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.
Available Technologies
Publications
URL for PUBMED publications: https://www.ncbi.nlm.nih.gov/labs/bibliography/dana.mukamel.1/bibliography/public/

Selected PUBLICATIONS and CONTRIBUTIONS TO SCIENCE 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 Compare series published by the Federal Government. More will be published in the coming years, as mandated by 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. Relevant 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]



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 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-E21. doi: http://dx.doi.org/10.5600/mmrr.004.01.a03. pii: mmrr2014.004.01.a03. doi: 10.5600/mmrr2014-004-01-a03. eCollection 2014.



5. PCOR and Personalized Decision Making: Medicine is undergoing an evolution – or perhaps a revolution – it is becoming personalized. With personalized medicine, patients should also have access to personalized decision making. My current research is moving in this direction, building on my past experience studying patient and provider behavior and preferences. In collaboration with a team of clinicians and IT scientists I am working on developing and testing new ways for patients, providers and policy makers to make decisions that are based on the latest available information, taking advantage of big data techniques, and personalizing the parameters of the decision to the decision maker. With AHRQ and PCORI funding, I have developed two apps. The first, currently at the end tail of an RCT, offers patients who need to choose a nursing home an interactive tool to create a personal composite quality measure from the CMS report card, and uses the composite to inform their choice. Initial results show higher patient satisfaction and shorter hospital stays. The second helps ovarian cancer patients to choose between two chemotherapy options, trading off worse quality of life during treatment for longer survival. This app is just now going into an RCT. Selected citations include:

a. Sorkin DH, Amin A, Weimer DL, Sharit J, Ladd H, Mukamel DB. “Rationale and study protocol for the Nursing Home Compare Plus (NHCPlus) randomized controlled trial: A personalized decision aid for patients transitioning from the hospital to a skilled-nursing facility” Journal of the Society for Clinical Trials 2016, 47 (2016) 139–145. PMCID: PMC4818159

b. Mukamel DB, Amin A, Weimer DL, Sharit J, Ladd H, Sorkin DH. “When Patients Create Their Own Nursing Home Report Card, Choices And Rankings Differ From The Government’s Version” Health Affairs 2016, Apr 1; 35(4):714-9. doi: 10.1377/hlthaff.2015.1340. PMCID: PMC4818159

c. Mukamel DB, Amin A, Weimer DL, Ladd H, Sharit J, Schwarzkopf R, Sorkin DH. “Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes” Health Services Research, 2016 Dec; 51(6):2076-2094. DOI: 10.1111/1475-6773.12588. Epub 2016 Oct 24. PMCID: PMC5134132. Best in ARM 2016.

d. Weimer DL, Saliba D, Ladd H, Shi Y, Mukamel DB. “Connecting Stars to People’s Wishes: Using Contingent Valuation to Develop Consumer-Based Weights for Health Report Cards” Health Services Research, 2019.
Grants
R01 AG027420 Nursing Home Quality and Variations in State Regulations – NIA. PI: Dana Mukamel, 2/1/07 – 1/31/12.
R01 AG023177 Nursing Homes Response to Quality Indicators’ Publication - NIA. PI: Dana Mukamel, 5/1/04 - 4/30/11.
R01 AG023077 Team Performance and Quality of Care in Nursing Homes. NIA, PI: Helena Temkin-Greener, 09/01/05 - 08/31/10
R01 HS016737-01 Improving Trauma Outcomes Using Hospital Performance Reports. PI: Laurent Glance, MD, 04/01/07 - 03/31/12
DK-069846 Reducing Diabetes Disparities Using Community Coaches, NIDDK. PI: Sheldon Greenfield, UCI, 04/01/07 - 03/31/11
California Health Care Foundation (CHCF) Evaluation of California AB1629 – Payment Incentives for Nursing Homes, 8/15/10-8/15/11.
R01 NR010727 End-Of-Life Quality of Care in Nursing Homes, NINR. PI: Helena Temkin-Greener, 9/30/2008 - 7/31/2012.
R01 AG032264 State Nursing Home Technical Assistance Programs: Variation & Impact on Quality, NIA. PI: Yue Li, 03/01/12 – 08/31/13.
HC 0103 Barriers to Access to LTC for MS patients, National Multiple Sclerosis Society. PI: Ekaterina Noyes, 07/01/09 –06/30/12.
NIA Physician Referral & Mental Disorder Related Disparities in PCI or CABG Surgery, PI: Yue Li, 03/15/12 – 06/30/13.
R21 HS021844 Patient Centered Quality Reporting: NHCPlus, AHRQ. PI: Dana Mukamel, 09/01/12 – 08/31/16.
R01 MD007662 Impacts of Nursing Home Competition & State Policies on Disparities in Quality, NIMHD. PI: Yue Li., 07/03/13 – 01/31/17.
PCORI Ovarian Cancer Patient-Centered Decision Aid, PI: Lari Wenzel, 06/17/13 – 06/17/16.
PCORI Improving Palliative and End-of-Life Care in Nursing Homes, PI: Helena Temkin-Greener, 04/01/13 - 04/30/17.
HHSH250200460221 BPHC Program Cost Analyses Data Support, HRSA. PI: Leiyu Shi, 11/01/11-12/28/13.
R03 AG045495 The Effect of Payer Status on Nursing Home Residents’ Hospitalizations, NIA. PI: Shubing Cai. Consultant.
California HealthCare Foundation Cost of Cancer Care in California, PI: Deborah Schrag. Consultant.
NIA Effects of Cost-Sharing for Post-Acute Care: Evidence from Medicare Advantage. PI: Amal Trivedi. Consultant.
RO1 AG051719 The Costs of Home Health and Patient Outcomes, NIA. PI: Dana Mukamel, 09/01/16 – 05/31/20. Total Costs: $2,145,418.
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, 09/30/16 – 04/30/19. Total Costs: $1,502,874.
1. CalMHSA California Mental Health Services Authority’s Innovation Technology-Based Mental Health Solutions Program. PI: Dara Sorkin. Project Dates: 11/15/18 – 6/30/22. Total Cost: $9,079,728.
Other Experience
Last updated
05/13/2019