Dana B Mukamel
Biographic Data
| ID | 5534785 |
|---|---|
| NAME | Dana B Mukamel |
| GIVEN NAMES | Dana B |
| FAMILY NAME | Mukamel |
| SIGNATURE | MUKAMEL D B |
| AFFILIATIONS | University of California, Irvine |
| ORCID | 0000-0003-4147-5785 |
| VERIFIED | Yes |
| TOTAL WORKS | 47 |
| TOTAL CITATIONS | 67 |
| AUTHOR COUNT | 47 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1989 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 4 |
Impact of Adverse Childhood Experiences (ACEs) on Mental Health Help-Seeking Among Asian American Adults
Cumulative adverse childhood experiences (ACEs) and psychological distress have been shown to negatively affect mental health across the lifespan. Less is known, however, about how ACEs might impact mental health help-seeking behavior in adulthood, especially among Asian Americans, a population with high exposure to trauma who also face cultural barriers to mental health care. The study’s aim was to evaluate the prevalence of ACEs within a sample…
Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions
Mental illness, problem, disorder, distress
Examination of the New Short-Stay Nursing Home Quality Measures
In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced 3 new quality measures (QMs) to its report card, Nursing Home Compare (NHC). These measures-rehospitalizations, emergency department visits, and successful discharges to the community-focus on short-stay residents. We offer a first analysis of nursing homes' performance in terms of these new measures. We examined their properties and distribution across nursing homes using des…
Impact of Nursing Home Palliative Care Teams on End-of-Life Outcomes
BACKGROUND: Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested. OBJECTIVE: Test the impact of PCTeams on end-of-life outcomes. RESEARCH DESIGN: Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention's placebo effe…
Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings
Objectives. To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non–health center settings in a context of significant growth. Methods. Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score–matched comparison groups receiving primary care in other settings…
Prototype End-of-Life Quality Measures Based on MDS 3 Data
BACKGROUND: The Nursing Home Compare (NHC) report card does not include end-of-life (EOL) quality measures (QMs). OBJECTIVES: To develop and examine the properties of EOL QMs. SUBJECTS: A total of 39,590 nursing home decedents in 626 facilities in New York State in fiscal year 2012. DESIGN: Statistical analyses of Minimum Data Set 3 data, including multivariable regression analyses and descriptive statistics. MEASURES: Death in the hospital, numb…
The Impact of Medicaid Payer Status on Hospitalizations in Nursing Homes
OBJECTIVES: To examine the association between payer status (Medicaid vs. private-pay) and the risk of hospitalizations among long-term stay nursing home (NH) residents who reside in the same facility. DATA AND STUDY POPULATION: The 2007-2010 National Medicare Claims and the Minimum Data Set were linked. We identified newly admitted NH residents who became long-stayers and then followed them for 180 days. ANALYSES: Three dichotomous outcomes-all-…
Have Racial Disparities in Ambulatory Care Sensitive Admissions Abated Over Time
BACKGROUND: Racial disparities in access to care and access to high-quality care have been persistent over many decades. They have been documented in all areas of health care, including ambulatory care. Policy initiatives have been implemented to address disparities and close the gaps in care that minorities face. Less is known about the effectiveness of these polices. OBJECTIVES: To evaluate whether disparities in quality of ambulatory care have…
Does Mandating Nursing Home Participation in Quality Reporting Make a Difference? Evidence From Massachusetts
BACKGROUND: Quality report cards have been shown to be effective in influencing patients' referrals and promoting quality improvement in some instances and not others. In this study, we investigate one of the mechanisms that may detract from their effectiveness: voluntary versus mandatory participation of nursing homes in public quality reporting. OBJECTIVES: To answer 2 questions: (1) Were the nursing homes choosing not to participate low-qualit…
Making Difficult Decisions
Objectives. We investigated how quality of care affects choosing a nursing home. Methods. We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model. Results. In all states, con…
Impact of Length of Stay After Coronary Bypass Surgery on Short-term Readmission Rate
OBJECTIVE: : To determine the effect of postoperative length of stay (LOS) on 30-day readmission after coronary artery bypass surgery. DATA SOURCES/STUDY SETTING: : We analyzed a final database consisting of Medicare claims of a cohort (N=157,070) of all fee-for-service beneficiaries undergoing bypass surgery during 2007-2008, the American Hospital Association annual survey file, and the rural urban commuting area file. STUDY DESIGN: : We regress…
Stability of Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders Among Long-term Nursing Home Residents
BACKGROUND: High-quality care for long-term nursing home residents should include discussions and follow-up on patients' end-of-life care wishes. Yet, recent changes to the Minimum Data Set data collection exclude this information from routine assessment of patients mandated by the Centers for Medicare & Medicaid Services, making the provision of high-quality end-of-life care less likely. We examined the stability of cardiopulmonary resuscitation…
The Relationship of California’s Medicaid Reimbursement System to Nurse Staffing Levels
BACKGROUND: Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. OBJECTIVE: To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. RESEARCH DESIGN: Two-stage limited-information maximum-likelihood regressions were used to model the relationship …
Racial Disparities in Rehospitalization Among Medicare Patients in Skilled Nursing Facilities
Objectives. We examined racial disparities in rehospitalization rates among a cohort of non-Hispanic White and Black Medicare beneficiaries admitted to skilled nursing facilities for postacute care. Methods. We analyzed the 2008 national Nursing Home Minimum Data Set, augmented with other databases. We used multivariable logistic regression to estimate overall racial disparities in rehospitalization rates within 30 days and 90 days of nursing fac…
Does State Regulation of Quality Impose Costs on Nursing Homes
BACKGROUND: Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs. OBJECTIVES: To estimate the costs associated with the regulation of quality of the nursing home industry. SAMPLE: This study includes 11,168 free-standing nursing homes nationally, between 2004 and 2006. RESEARCH DESIGN: Data included information from the Medicare cos…
Racial Disparities in In-hospital Death and Hospice Use Among Nursing Home Residents at the End of Life
BACKGROUND: Significant racial disparities have been reported regarding nursing home residents' use of hospital and hospice care at the end of life (EOL). OBJECTIVE: To examine whether the observed racial disparities in EOL care are due to within-facility or across-facility variations. RESEARCH DESIGN AND SUBJECTS: Cross-sectional study of 49,048 long-term care residents (9.23% black and 90.77% white) in 555 New York State nursing homes who died …
Measuring Quality for Public Reporting of Health Provider Quality
Public quality reports of hospitals, health plans, and physicians are being used to promote efficiency and quality in the health care system. Shrinkage estimators have been proposed as superior measures of quality to be used in these reports because they offer more conservative and stable quality ranking of providers than traditional, nonshrinkage estimators. Adopting the perspective of a patient faced with choosing a local provider on the basis …
Racial Disparities in Receipt of Influenza and Pneumococcus Vaccinations Among US Nursing-Home Residents
Objectives. We examined racial disparities in receipt and documentation of influenza and pneumococcus vaccinations among nursing-home residents. Methods. We performed secondary analyses of data from a nationally representative survey of White (n = 11 448) and Black (n = 1174) nursing-home residents in 2004. Bivariate and multivariate analyses determined racial disparities in receipt of influenza vaccination in 2003 and 2004, receipt of pneumococc…
The Volume-Outcome Relationship in Nursing Home Care
BACKGROUND: Extensive evidence has demonstrated a relationship between patient volume and improved clinical outcomes in hospital care. This study sought to determine whether a similar association exists between nursing home volume of long-term care residents and rates of decline in physical function. METHODS: We conducted retrospective analyses on the 2004 and 2005 Minimum Data Set files that contain 605,433 eligible long-term residents in 9336 n…
Pressure Ulcer Prevalence Among Black and White Nursing Home Residents in New York State
OBJECTIVE: The occurrence of pressure ulcers (PUs) in nursing homes is a marker for poor quality of care. We examine whether differences in PU prevalence between black and white residents are due to within- or across-facility disparities. METHODS: Minimum Data Sets (2006-2007) are linked with the Online Survey Certification and Reporting database. Long-term care residents with high risk for PUs are identified. The dependent variable is dichotomou…
How Well Do Hospital Mortality Rates Reported in the New York State Cabg Report Card Predict Subsequent Hospital Performance
BACKGROUND: The use of mortality report cards as the basis for hospital choice assumes that a hospital's current performance is predicted by its past performance. OBJECTIVE: To assess the accuracy of hospital risk-adjusted mortality rates reported in the New York State (NYS) coronary artery bypass graft (CABG) report card for predicting subsequent hospital mortality. METHODS: We performed a retrospective study based on hospital mortality measures…
Nursing Home Environment and Organizational Performance
BACKGROUND: Work environment attributes--job design, teamwork, and work effectiveness--are thought to influence nursing home (NH) quality of care. However, few studies tested these relationships empirically. OBJECTIVE: We investigated the relationship between these work environment attributes and quality of care measured by facility-level regulatory deficiencies. METHODS: Data on work environment were derived from survey responses obtained (in 20…
Changes in Clinical and Hotel Expenditures Following Publication of the Nursing Home Compare Report Card
BACKGROUND: Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in their search and choice of a nursing home. OBJECTIVES: To examine the hypothesis that nur…
Measuring Work Environment and Performance in Nursing Homes
BACKGROUND: Qualitative studies of the nursing home work environment have long suggested that attributes such as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. OBJECTIVES: This study is designed to develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability …
Metropolitan governance, residential segregation, and mortality among African Americans
OBJECTIVES: This study tested the hypothesis that the degree to which local government is metropolitanized is associated with mortality rates for African Americans and with residential segregation, which has itself previously been shown to be positively associated with mortality among African Americans. METHODS: One hundred fourteen US standard metropolitan statistical areas were examined. The primary dependent variable was the age-adjusted, race…
Nursing Homes' Response to the Nursing Home Compare Report Card
These findings suggest that the Nursing Home Compare report card has the potential to positively affect nursing home quality
Racial Disparities in Rehospitalization Among Medicare Patients in Skilled Nursing Facilities
Objectives. We examined racial disparities in rehospitalization rates among a cohort of non-Hispanic White and Black Medicare beneficiaries admitted to skilled nursing facilities for postacute care. Methods. We analyzed the 2008 national Nursing Home Minimum Data Set, augmented with other databases. We used multivariable logistic regression to estimate overall racial disparities in rehospitalization rates within 30 days and 90 days of nursing fac…
Racial Disparities in Receipt of Influenza and Pneumococcus Vaccinations Among US Nursing-Home Residents
Objectives. We examined racial disparities in receipt and documentation of influenza and pneumococcus vaccinations among nursing-home residents. Methods. We performed secondary analyses of data from a nationally representative survey of White (n = 11 448) and Black (n = 1174) nursing-home residents in 2004. Bivariate and multivariate analyses determined racial disparities in receipt of influenza vaccination in 2003 and 2004, receipt of pneumococc…
Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings
Objectives. To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non–health center settings in a context of significant growth. Methods. Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score–matched comparison groups receiving primary care in other settings…
Making Difficult Decisions
Objectives. We investigated how quality of care affects choosing a nursing home. Methods. We examined nursing home choice in California, Ohio, New York, and Texas in 2001, a period before the federal Nursing Home Compare report card was published. Thus, consumers were less able to observe clinical quality or clinical quality was masked. We modeled nursing home choice by estimating a conditional multinomial logit model. Results. In all states, con…
Measuring Quality for Public Reporting of Health Provider Quality
Public quality reports of hospitals, health plans, and physicians are being used to promote efficiency and quality in the health care system. Shrinkage estimators have been proposed as superior measures of quality to be used in these reports because they offer more conservative and stable quality ranking of providers than traditional, nonshrinkage estimators. Adopting the perspective of a patient faced with choosing a local provider on the basis …
How Might A Low-Cost Hospital System Look
An innovative, collaborative approach to promoting the effective and efficient delivery of hospital services and to maintaining the solvency of the nine participating hospitals in the greater Rochester, New York area has been successful. An evaluation of the early years (1980-1984) of the Hospital Experimental Payments Program (HEP) shows: 1) per capita hospital costs in Rochester increased at half the rate of increase of the national average; 2)…
Risk-Adjusted Outcome Measures and Quality of Care in Nursing Homes
OBJECTIVES: This study examines the use of the patient review instrument (PRI), a reimbursement reporting system used by the New York State Department of Health, to assess quality of care based on risk-adjusted outcomes. METHODS: Data for all residents in approximately 550 nursing homes in upstate New York are used to develop five risk-adjusted outcome measures. The five measures are rates of decline in functional status activities of daily livin…
Metropolitan governance, residential segregation, and mortality among African Americans
OBJECTIVES: This study tested the hypothesis that the degree to which local government is metropolitanized is associated with mortality rates for African Americans and with residential segregation, which has itself previously been shown to be positively associated with mortality among African Americans. METHODS: One hundred fourteen US standard metropolitan statistical areas were examined. The primary dependent variable was the age-adjusted, race…
Nursing Home Costs and Risk-Adjusted Outcome Measures of Quality
BACKGROUND: The inadequacy of quality of care in nursing homes has been and continues to be a focus of public concerns. Understanding the relationship between quality and costs can offer guidance to policies designed to encourage high quality. OBJECTIVES: To investigate the relationship between costs and quality of care in nursing homes, and to test the hypothesis that higher quality may be associated with lower costs. RESEARCH DESIGN: Statistica…
Use of Resident-Origin Data to Define Nursing Home Market Boundaries
Previous studies of nursing home markets have assumed that a nursing home's market is coincident with the boundaries of the county in which it is located. We test this assumption by using the zip code of residence for Medicare beneficiaries admitted into a nursing home in New York state in the periods 1992-93 and 1996-97. We find that nursing homes located in urban areas have markets that are a fraction of the size of the county in which they are…
Health Care Services Utilization at the End of Life in a Managed Care Program Integrating Acute and Long-Term Care
BACKGROUND: The period preceding death is often characterized by increased utilization of medical resources. There is an ongoing debate on the reasons for and the appropriateness of increased utilization at the end of life. OBJECTIVES: To study end-of-life practices in the PACE program and to assess the contribution of individual characteristics versus program site to the variation in use of services. RESEARCH DESIGN: Retrospective analyses of ut…
Development of a Risk-Adjusted Urinary Incontinence Outcome Measure of Quality for Nursing Homes
BACKGROUND: Quality of nursing home care is of ongoing concern. The availability of uniform, patient-level information-the Minimum Data Set (MDS)-offers the opportunity to assess quality based on risk-adjusted health outcomes. OBJECTIVE: To develop a risk-adjusted measure of quality based on urinary incontinence (UI) outcomes for nursing homes, derived from the MDS. RESEARCH DESIGN: A retrospective statistical analysis of individual resident leve…
Quality Report Cards, Selection of Cardiac Surgeons, and Racial Disparities
Quality report cards have become common in many health care markets. This study evaluates their effectiveness by examining the impact of the New York State (NYS) Cardiac Surgery Reports on selection of cardiac surgeons. The analyses compares selection of surgeons in 1991 (pre-report publication) and 1992 (post-report publication). We find that the information about a surgeon's quality published in the reports influences selection directly and dim…
Measuring Interdisciplinary Team Performance in a Long-Term Care Setting
OBJECTIVES: The objectives of this study were to test the reliability and the validity of a survey instrument for assessing interdisciplinary team performance in long-term care settings and to measure team performance in the Program of All-Inclusive Care for the Elderly (PACE). RESEARCH DESIGN AND METHODS: The analysis is based on 1220 surveys completed by team members of 26 PACE programs. Cronbach's alphas, analysis of variance, and regression m…
Social Support and Risk-Adjusted Mortality in a Frail Older Population
OBJECTIVE: The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services. RESEARCH DESIGN AND METHODS: The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the Elderly (PACE). Information about the enrollees is obtained from dataPACE. Semiparametric Cox proportional hazards models are esti…
Impact of Changing the Statistical Methodology on Hospital and Surgeon Ranking
BACKGROUND: Risk adjustment is central to the generation of health outcome report cards. It is unclear, however, whether risk adjustment should be based on standard logistic regression, fixed-effects or random-effects modeling. OBJECTIVE: The objective of this study was to determine how robust the New York State (NYS) Coronary Artery Bypass Graft (CABG) Surgery Report Card is to changes in the underlying statistical methodology. METHODS: Retrospe…
Disenrollment From an Acute/Long-Term Managed Care Program (Pace)
BACKGROUND: The Program of All-Inclusive Care for the Elderly (PACE) is an acute/long-term managed care plan designed to care for the most frail and vulnerable Medicare beneficiaries. To our knowledge, this is a first study to examine patterns and predictors of disenrollment from PACE. OBJECTIVE: PACE, with its comprehensive delivery system, dual capitation, and a focus on the most vulnerable population, may be expected to achieve low rates of ex…
Nursing Homes' Response to the Nursing Home Compare Report Card
These findings suggest that the Nursing Home Compare report card has the potential to positively affect nursing home quality
Are Patients With Coexisting Mental Disorders More Likely to Receive Cabg Surgery From Low-Quality Cardiac Surgeons
BACKGROUND: Presence of a mental disorder has been shown to be associated with reduced access to medical and surgical services. Little is known, however, about the relationship between mental disorders and the quality of medical/surgical care received. METHODS: We analyzed New York State hospital discharge data between 2001 and 2003 and New York's publicly-released Cardiac Surgery Report of surgeons' risk-adjusted mortality rate, to evaluate whet…
Changes in Racial Disparities in Access to Coronary Artery Bypass Grafting Surgery Between the Late 1990s and Early 2000s
BACKGROUND: Racial disparities in medical care in the United States are pervasive and persistent. Minorities, African American patients in particular, have lower utilization rates for coronary artery bypass graft surgery (CABG) and, compared with white patients, they receive care from surgeons with worse records of performance. OBJECTIVES: We sought to examine the persistence of disparities in CABG care (overall access to surgery and access to hi…
Gender Differences in Healthcare-Seeking Behavior for Urinary Incontinence and the Impact of Socioeconomic Status
BACKGROUND: Despite the gender difference in etiology, prevalence and management of urinary incontinence (UI) among community-living older adults, little is known about the effect of gender on their healthcare-seeking behaviors. OBJECTIVE: To determine gender differences in professional care seeking, receipt of UI treatment, and the impact of age and socioeconomic status. RESEARCH DESIGN: National survey of Medicare managed care enrollees in 2003…
Use of a Matching Algorithm to Evaluate Hospital Coronary Artery Bypass Grafting Performance as an Alternative to Conventional Risk Adjustment
BACKGROUND: Although public reporting of hospital and physician performance is a cornerstone of the effort to improve health care quality, the optimal approach to risk adjustment is unknown. OBJECTIVE: We sought to assess hospital quality using a matching algorithm based on a generalized distance metric and to compare this approach to the more traditional regression-based approach. DESIGN/ DATA SOURCE: This was a retrospective study using the New…
Interpreting Market Share Changes as Evidence for Effectiveness of Quality Report Cards
Mukamel, Dana B. PhD; Weimer, David L. PhD; Mushlin, Alvin I. MD, ScM Author Information
Mental Illness and Hospitalization for Ambulatory Care Sensitive Medical Conditions
BACKGROUND: Hospitalization due to ambulatory care sensitive (ACS) medical conditions is widely used as an indicator of poor primary care access and effectiveness. It is unknown whether patients with mental disorders have higher ACS admission rate, compared with patients without mental disorders. OBJECTIVE: To compare the ACS admission pattern and its resultant hospital cost and length of stay (LOS) between medical patients with and without coexi…
Does Risk Adjustment of the CMS Quality Measures for Nursing Homes Matter
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) publish a report card for nursing homes with 19 clinical quality measures (QMs). These measures include minimal risk adjustment. OBJECTIVES: To develop QMs with more extensive risk adjustment and to investigate the impact on quality rankings. RESEARCH DESIGN: Retrospective analysis of individual level data reported in the Minimum Data Set (MDS). Random effect logistic models were us…
Impact of the Present-on-Admission Indicator on Hospital Quality Measurement
BACKGROUND: The Agency for Healthcare Research and Quality (AHRQ) has constructed Inpatient Quality Indicator (IQI) mortality measures to measure hospital quality using routinely available administrative data. With the exception of California, New York State, and Wisconsin, administrative data do not include a present-on-admission (POA) indicator to distinguish between preexisting conditions and complications. The extent to which the lack of a PO…
Measuring Work Environment and Performance in Nursing Homes
BACKGROUND: Qualitative studies of the nursing home work environment have long suggested that attributes such as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. OBJECTIVES: This study is designed to develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability …
The Costs of Turnover in Nursing Homes
BACKGROUND: Turnover rates in nursing homes have been persistently high for decades, ranging upwards of 100%. OBJECTIVES: To estimate the net costs associated with turnover of direct care staff in nursing homes. DATA AND SAMPLE: Nine hundred two nursing homes in California in 2005. Data included Medicaid cost reports, the Minimum Data Set, Medicare enrollment files, Census, and Area Resource File. RESEARCH DESIGN: We estimated total cost function…
Measuring Quality for Public Reporting of Health Provider Quality
Public quality reports of hospitals, health plans, and physicians are being used to promote efficiency and quality in the health care system. Shrinkage estimators have been proposed as superior measures of quality to be used in these reports because they offer more conservative and stable quality ranking of providers than traditional, nonshrinkage estimators. Adopting the perspective of a patient faced with choosing a local provider on the basis …
Racial Disparities in Receipt of Influenza and Pneumococcus Vaccinations Among US Nursing-Home Residents
Objectives. We examined racial disparities in receipt and documentation of influenza and pneumococcus vaccinations among nursing-home residents. Methods. We performed secondary analyses of data from a nationally representative survey of White (n = 11 448) and Black (n = 1174) nursing-home residents in 2004. Bivariate and multivariate analyses determined racial disparities in receipt of influenza vaccination in 2003 and 2004, receipt of pneumococc…
Medicine (43 works) · Geriatric Care and Nursing Homes (29 works) · Nursing (28 works) · Nursing homes (21 works) · Health care (17 works) · Frailty in Older Adults (13 works) · Business (12 works) · Quality (philosophy) (12 works) · Emergency Medicine (11 works) · Emergency Medicine (11 works)