About

Joyce Liao is a faculty member in the Department of Laboratory Medicine & Pathology at UW Medicine, University of Washington. The department serves as a regional resource for clinical laboratory services, integrating sophisticated testing and informatics capabilities with the resources of an academic institution to provide clinical and anatomical pathology services. The department is recognized for excellence in clinical training, world-class research initiatives, and a commitment to community service, serving the five-state WWAMI region, including Washington, Wyoming, Alaska, Montana, and Idaho. While specific research focus areas or key contributions are not detailed in the provided text, the department's broad scope encompasses diagnostic services in anatomic and surgical pathology, clinical pathology, and related research and educational programs.

Research topics

• Business
• Finance
• Medicine
• Actuarial science
• Environmental health
• Public economics
• Economic growth
• Political Science
• Computer Science
• Economics
• Internal medicine

Selected publications

• Health Care Utilization and Out-of-Pocket Expenses in the 30-, 60-, and 90-Day Postoperative Period After Hand Trauma

  Hand · 2026-01-07

  articleOpen accessSenior author

  BACKGROUND: There are knowledge gaps about postsurgical utilization and spending after hand trauma, which has implications for outcomes and access to care. METHODS: Using 2019-2022 national claims, we examined 30-, 60-, and 90-day postsurgical health care utilization and out-of-pocket (OOP) expenses of flexor tendon repairs, open reduction internal fixation (ORIF) of a distal radius fracture, and digital replantation/revascularization. Multivariable regression models were used to examine the association between characteristics and postsurgical utilization and OOP expenses. RESULTS: Among 22 170 patients, a large proportion of patients had utilization within 30 days (19 188; 87%), 60 days (20 022; 91%), and 90 days (20 170; 92%) after surgery, translating to OOP expenses of $41 at 30 days versus $107 at 90 days with substantial procedural variation (eg, 90-day OOP expenses after ORIF of a distal radius fracture of $98 vs $211 for flexor tendon repair). Patients undergoing flexor tendon repair had greater odds of reoperation/hospitalization at 30 days (adjusted odds ratio [aOR] = 1.8, 95% confidence interval [CI] = 1.5-2.1), 60 days (aOR = 1.8, 95% CI = 1.5-2.0), and 90 days (aOR = 1.6, 95% CI = 1.4-1.8) compared with ORIF of distal radius fractures. Flexor tendon repair was associated with 52% greater OOP expenses at 30 days (95% CI = 1.4-1.6) and 33% greater OOP expenses at 90 days (95% CI = 1.2-1.4) compared with ORIF of distal radius fractures. CONCLUSIONS: There was substantial variation in utilization and patient OOP expenses 30, 60, and 90 days postoperatively. These findings can help inform policy and practice leaders as they implement strategies to minimize patient financial burden of health care.

  PublisherDOI

• Nudges to Clinicians and Patients for Influenza Vaccines During Visits

  JAMA Internal Medicine · 2026-01-05 · 3 citations

  articleOpen access

  Importance: Annual influenza vaccination reduces burden of disease for older adults, but rates remain suboptimal. Objective: To evaluate if a multicomponent nudge intervention to clinicians and patients increases vaccine completion during primary care visits. Design, Setting, and Participants: The pragmatic BE IMMUNE (Behavioral Economics to Improve and Motivate Vaccination in Primary Care Using Nudges Through the Electronic Health Record) randomized clinical trial took place across 48 primary care clinics through Penn Medicine (Philadelphia, Pennsylvania) and UW Medicine (Seattle, Washington). Patients 50 years and older who were scheduled for a primary care visit and were due for an influenza vaccine within the active intervention period (September 25, 2023, to February 20, 2024) were included. Interventions: Clinics were randomized in a 2:1 ratio to receive (1) previsit text message reminders to patients, (2) an automatic pended order, and (3) monthly comparisons of panel vaccination rates to peer clinicians, or usual care. Additionally, patients in the intervention arm who were identified as high risk for noncompletion were individually randomized 1:1 to receive previsit bidirectional text messaging or a standard text reminder. Main Outcomes and Measures: The primary outcome was influenza vaccination during the visit. Results: Among 80 039 patients across 47 clinics, the mean (SD) age was 65.8 (10.2) years, and 56.0% were female while 43.6% were male. The adjusted odds ratio (AOR) for vaccine completion comparing intervention to usual care was 1.28 (97.5% CI, 1.13-1.45; adjusted P < .001). The probability of completion in the intervention was 31.4% compared to 26.4% under usual care, with a risk difference of 5.1 percentage points (97.5% CI, 2.6-7.5 percentage points; adjusted P < .001). The adjusted odds ratio comparing bidirectional vs standard text messaging among high-risk patients was not statistically significant (1.00; 97.5% CI, 0.98-1.02; adjusted P = .92). Conclusions and Relevance: In this randomized clinical trial, the multicomponent nudge resulted in a statistically significant higher rate of influenza vaccination during the primary care visit, but the bidirectional text messaging did not further increase vaccination in the high-risk group. Trial Registration: ClinicalTrials.gov Identifier: NCT06057727.

  PublisherOA PDFDOI

• Growth of zero-premium Medicare Advantage plans in counties with high cancer mortality

  JNCI Journal of the National Cancer Institute · 2026-01-07 · 1 citations

  articleSenior author

  BACKGROUND: Zero-premium Medicare Advantage (MA) plans have rapidly become the most popular MA plan type in the US, despite potentially restrictive benefit design. It remains unclear whether the growth of these plans aligns with the county-level cancer mortality. METHODS: We conducted a two-part, county-level ecological study. First, using CMS enrollment data (2019-2024) and NCHS mortality data (2018-2022), we examined longitudinal trends in the market share of zero-premium MA plans overall and across counties by their cancer-mortality rate quartiles. Second, we performed a cross-sectional, mixed-effects logistic regression analysis of 2019-2024 plan-level data to evaluate the association between zero-premium MA and low plan quality (<4 stars) and whether this relationship varied by county cancer-mortality rate quartile. RESULTS: The market share of zero-premium MA plans increased from 60.2% to 75.9% of the MA market between 2019 and 2024, with disproportionately greater growth in counties with higher cancer mortality rates (Q4: +28.7 percentage points[pp] vs Q1: +23.8pp; p-interaction < 0.001). In adjusted analyses, zero-premium plans also had significantly higher odds of having <4 star ratings compared with premium-charging plans (aOR 1.68; 95% CI, 1.64-1.72), particularly in counties with highest cancer mortality rates (aOR 1.83; 95% CI, 1.69-1.98, p-interaction < 0.01). CONCLUSIONS: The rapid expansion of zero-premium MA plans has been disproportionately concentrated in communities with highest cancer mortality rates. These plans are more likely to have lower CMS star ratings than premium-charging MA plans. Rapid zero-premium MA plan adoption raises concerns about equitable access to high-quality care for patients with cancer.

  PublisherDOI

• Use of Social Determinants of Health Z-Codes in Hand Trauma Patients

  Hand · 2026-05-04

  articleOpen accessSenior author

  BACKGROUND: Hand trauma patients are more likely to be affected by social determinants of health (SDOH) that can adversely affect surgical outcomes. The introduction of z-codes reflecting SDOH has increased the ability to systematically capture SDOH, such as economic circumstances and social support. However, little is known about the uptake of z-codes for identifying SDOH and the characteristics of hand trauma patients with and without documented SDOH z-codes. METHODS: This analysis used 2015-2025 national data from EPIC Cosmos for patients undergoing common surgical procedures for hand trauma. We assessed for the presence of SDOH using z-codes and compared characteristics of patients with and without documented SDOH. RESULTS: Only 1.7% of surgically treated hand trauma patients had documented SDOH z-codes. Patients with SDOH were younger, Black, living in urban areas, and insured through Medicaid or Medicare compared with patients without SDOH. Between 2015 and 2025, the uptake of z-codes increased from 0.4% in 2015 to 4.1% in 2025, with housing, economic, and social support determinants being most common. CONCLUSIONS: While z-codes enable greater capture of SDOH, adoption was limited over the last decade. Strategies are needed to promote more comprehensive identification of SDOH among surgically treated hand trauma populations.

  PublisherDOI

• Association Between Mobile Health Clinic Use, Care Coordination, and Continuity in Rural Areas: A Survey Study in Taiwan

  Research Square · 2025-11-25

  preprintOpen access
  PublisherOA PDFDOI

• Cost-related barriers to medication use among diverse participants with obesity-associated asthma

  Journal of Managed Care & Specialty Pharmacy · 2025-08-30

  articleOpen access

  BACKGROUND: Individuals with obesity-associated asthma (OAA) have worse health outcomes than those with asthma and healthy weight (no OAA). The impact of cost barriers on medication use and how it varies by racial and ethnic groups is unclear. OBJECTIVE: To assess the impact of cost barriers on medication use in OAA across racial and ethnic groups. METHODS: ). Main measures included self-reported cost-related barriers to medication use. RESULTS: < 0.001, respectively). CONCLUSIONS: Significant disparities exist in cost-related barriers among individuals with OAA from different ethnic backgrounds. This highlights the need for tailored health care interventions that address the specific needs of diverse populations, aiming to reduce health disparities and improve asthma outcomes.

  PublisherOA PDFDOI

• Overlap between transitional care management after hospital discharge and alternative payment models

  Journal of Hospital Medicine · 2025-07-21

  articleSenior author

  Care coordination is integral during posthospital transitions. The Centers for Medicare & Medicaid Services (CMS) has sought to promote post-hospitalization care coordination through population-based alternative payment models (APMs) and transitional care management (TCM) services. Both can be associated with benefits, but data are lacking about their overlap. Using 2018-2019 100% Medicare claims, we compared characteristics and quantified overlap across APM and TCM groups. Of 7,034,244 beneficiaries and 11,148,266 discharges, 41.6% were APM-aligned and 14.5% involved TCM. TCM services were received in 19.7% of APM-aligned discharges; among discharges involving TCM, 56.7% occurred among APM-aligned beneficiaries. Relative to non-APM beneficiaries, APM-aligned beneficiaries receiving TCM were less likely to be from historically underserved populations, suggesting potential health disparity concerns. This early descriptive analysis offers novel evidence about TCM and APMs as major national policy investments, highlighting the need for future work on overlap and its effects on care coordination and patient outcomes.

  PublisherDOI

• Priced by Association: How Ownership Can Affect Radiology Practice Revenue

  Journal of the American College of Radiology · 2025-08-15

  articleSenior author
  PublisherDOI

• Health system outcomes following an integrated intervention to improve detection of cognitive impairment using a novel training program for primary care

  Alzheimer s & Dementia · 2025-12-01

  articleOpen access

  BACKGROUND: Primary care providers (PCPs) are at the forefront of evaluating cognitive concerns and detecting mild cognitive impairment and dementia, but they generally lack training and tools to do so. METHOD: An intervention consisting of education webinars integrated with checklists in the electronic health record (EHR) and a set of exam room tools was developed and implemented across a large primary care system of 14 community-based clinics (94 PCPs). Outcomes from the EHR included the number of cognitive assessments recorded by PCPs in the EHR and the number of patients who received a new diagnosis of mild cognitive impairment or dementia. RESULT: Over two years of the program, the average number of cognitive assessments entered by quarter into the EHR increased from 6.6 to 42.8 (p = 0.01). In addition, the average number of new diagnoses of mild cognitive impairment or dementia per quarter increased from 17.0 to 37.8 (p = 0.02). See Figures 1 and 2. Referrals to specialty care were reported as being more useful, because they more often included assessments of cognitive function and a review of potential reversible causes of cognitive impairment. CONCLUSION: An intervention integrating PCP education with workflow tools increased cognitive testing and diagnoses of mild cognitive impairment and dementia in a large primary care health system. Such change is essential for patients to receive improved care for Alzheimer's disease and related dementias.

  PublisherOA PDFDOI

• National Adoption of Artificial Intelligence Software in Medicare Among Radiologists

  Journal of the American College of Radiology · 2025-09-11 · 1 citations

  articleSenior author
  PublisherDOI

Frequent coauthors

• Amol S. Navathe

  University of Pennsylvania

  201 shared

• Ashok Reddy

  Northwest University

  45 shared

• Leah M. Marcotte

  University of Washington

  37 shared

• Lingmei Zhou

  Ningbo Medical Center Lihuili Hospital

  34 shared

• Jingsan Zhu

  University of Pennsylvania

  32 shared

• Deborah S. Cousins

  University of Pennsylvania

  30 shared

• Christoph I. Lee

  University of Washington

  30 shared

• David R. Flum

  University of Washington

  26 shared