Collboration Research

Comparison of Distal Radius Fracture Outcomes in Older Adults: Casting vs Surgery and Chronologic vs Physiologic Age

Question addressed:
To evaluate longitudinal functional outcomes following casting versus surgical management of distal radius fractures in older adults, and to assess whether physiologic age better predicts recovery trajectories than chronologic age.

Study design and data:

• Multicenter randomized clinical trial (WRIST)
• Longitudinal functional outcome measurements collected up to one year post-treatment

My role:

• Conducted longitudinal analysis using linear mixed-effects models to account for within-subject correlation
• Addressed confounding and performed subgroup and age-stratified analyses
• Collaborated closely with clinicians on interpretation and manuscript preparation

Impact and outcome:

• Provided evidence-based guidance on treatment selection for older adults with distal radius fractures
• Demonstrated the importance of physiologic age in predicting functional recovery
• Published in JAMA Network Open (2023). Full text

Impact of Regional Surgeon Competition on Breast Reconstruction Use, Cost, and Outcomes After Mastectomy

Question addressed:
To evaluate how regional surgeon competition influences access to breast reconstruction, healthcare costs, and patient outcomes following mastectomy.

Study design and data:

• Cross-sectional observational study using MarketScan insurance claims data (2009–2020)
• Market-level surgeon competition quantified using the Herfindahl–Hirschman Index (HHI)

My role:

• Conducted multivariable regression analyses to assess associations between market competition, utilization, and healthcare costs
• Contributed to interpretation of policy-relevant findings related to market structure and patient care

Impact and outcome:

• Provided evidence on how regional market competition shapes access to reconstructive surgery after mastectomy
• Highlighted economic and utilization consequences of surgeon market concentration
• Published in Plastic and Reconstructive Surgery (2025). Full text

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Affordable Care Act

Question addressed:
To assess changes in access to hand surgery for patients with rheumatoid arthritis before versus after the implementation of the Affordable Care Act, with a focus on disparities in utilization, timing, and cost.

Study design and data:

• Cross-sectional observational study using national surgical data (2009–2020)
• Primary outcomes included time to surgery, surgical incidence, and healthcare costs

My role:

• Conducted statistical analyses comparing pre- and post-ACA cohorts
• Applied multivariable regression and piecewise linear regression to evaluate changes in access over time
• Contributed to interpretation of access and cost outcomes

Impact and outcome:

• Quantified policy-associated changes in surgical access for patients with rheumatoid arthritis
• Identified persistent disparities in access related to insurance coverage and geographic factors
• Published in JAMA Surgery (2024). Full text

Healthcare Utilization and Economic Outcomes of Thumb CMC Arthroplasty: Nationwide Claims-Based Analyses

Overview:
A series of observational studies using nationwide insurance claims data to evaluate treatment strategies, revision risk, and long-term healthcare utilization and costs associated with thumb carpometacarpal (CMC) arthroplasty.

Study components:

• Surgical vs Nonoperative Management of Thumb CMC Arthritis
  Compared long-term healthcare costs and utilization between operative and nonoperative treatments using generalized linear mixed-effects models with propensity score weighting.
  Published in The Journal of Hand Surgery (Asian-Pacific Volume) (2024).
• Revision Thumb CMC Arthroplasty: Risk Factors and Economic Implications
  Identified patient- and treatment-related risk factors for revision surgery using multivariable logistic regression, and quantified the impact of revision procedures on long-term healthcare cost and utilization using GLMMs with propensity score weighting.
  Published in Plastic and Reconstructive Surgery (2025). Full text

My role:

• Applied causal inference methods in longitudinal obsevational study
• Implemented generalized linear mixed-effects models for longitudinal cost and utilization outcomes
• Collaborated with clinicians on interpretation of economic and surgical outcomes

Outcomes of Adults with COPD Hospitalized with Influenza

Question addressed:
To evaluate the risk of severe in-hospital outcomes among adults with pre-existing chronic obstructive pulmonary disease (COPD) hospitalized with laboratory-confirmed influenza.

Study design and data:

• Population-based influenza hospitalization surveillance (2014–2024)
• Adults hospitalized with laboratory-confirmed influenza
• Ordinal severe outcomes: ICU admission, invasive mechanical ventilation, or in-hospital death

My role:

• Conducted outcome analyses using proportional odds models for ordinal severity outcomes
• Performed sensitivity analyses to assess robustness of findings across model specifications

Impact and outcome:

• Quantified the increased risk of severe hospital outcomes among influenza patients with pre-existing COPD
• Provided population-level evidence to inform clinical risk stratification and inpatient management
• Manuscript completed

Contributions of Worry and Social Anxiety to Paranoia

Question addressed:
To examine the cross-sectional and longitudinal contributions of worry and social anxiety to paranoia in clinical and non-clinical populations.

Study design and data:

• Adults with schizophrenia spectrum disorders (SSDs) and non-clinical comparison participants
• Cross-sectional and longitudinal self-report assessments of worry, social anxiety, and paranoia

My role:

• Conducted longitudinal analyses using generalized estimating equations (GEE) to account for within-subject correlation
• Quantified effect sizes and variance explained using hierarchical regression with bootstrapping
• Performed extensive sensitivity analyses across symptom subscales and covariate adjustment strategies

Impact and outcome:

• Demonstrated independent and additive contributions of worry and social anxiety to paranoia across populations
• Provided longitudinal evidence supporting cognitive-affective targets for intervention
• Manuscript completed