Publications by authors named "Liza Reifler"
Objective: To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia.
Study Design: In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record.
Introduction: Obesity affects four in ten US adults. One of the most prevalent health-related social risk factors in the US is housing instability, which is also associated with cardiovascular health outcomes, including obesity. The objective of this research brief is to examine the association between housing instability with obesity status among a representative sample of insured adults across seven integrated health systems.
View Article and Find Full Text PDFImportance: Pregnant people and infants are at high risk of severe COVID-19 outcomes. Understanding changes in attitudes toward COVID-19 vaccines among pregnant and recently pregnant people is important for public health messaging.
Objective: To assess attitudinal trends regarding COVID-19 vaccines by (1) vaccination status and (2) race, ethnicity, and language among samples of pregnant and recently pregnant Vaccine Safety Datalink (VSD) members from 2021 to 2023.
Objective: To assess the validity of electronic health record (EHR)-based influenza vaccination data among adults in a multistate network.
Methods: Following the 2018-2019 and 2019-2020 influenza seasons, surveys were conducted among a random sample of adults who did or did not appear influenza-vaccinated (per EHR data) during the influenza season. Participants were asked to report their influenza vaccination status; self-report was treated as the criterion standard.
Article Synopsis
- A study explored racial and ethnic disparities in influenza vaccination coverage among pregnant women in the U.S., finding that non-Hispanic White women had higher vaccination rates than Hispanic and non-Hispanic Black women.
- The research involved surveys conducted after the 2019-2020 and 2020-2021 flu seasons, with significant oversampling of non-Hispanic Black and unvaccinated women to assess vaccine-related attitudes influencing vaccination coverage.
- The study concluded that attitudes towards the vaccine (like safety concerns) significantly contributed to the observed disparities in vaccination rates, even in a context where overall vaccination coverage was relatively high among pregnant women.
Objective: To determine whether a multicomponent intervention focused on early peanut introduction was associated with a lower peanut allergy incidence in young children.
Methods: The study cohort comprised all children born January 1, 2013 through December 31, 2018 receiving care at a large health care organization. Intervention activities occurred over 16 months and included provider educational programs, electronic health record tools, and new patient instructions.
Article Synopsis
- A study aimed to investigate the link between aluminum exposure from vaccines in children under 24 months and the development of persistent asthma between 24 and 59 months of age.
- The research was based on the Vaccine Safety Datalink and analyzed data from 326,991 children, finding that higher aluminum exposure was associated with higher rates of persistent asthma, especially in those with eczema.
- The conclusion suggests a possible connection but calls for further research due to the small effect sizes and potential confounding factors.
Objectives: Having accurate influenza vaccination coverage estimates can guide public health activities. The objectives of this study were to (1) validate the accuracy of electronic health record (EHR)-based influenza vaccination data among pregnant women compared with survey self-report and (2) assess whether survey respondents differed from survey nonrespondents by demographic characteristics and EHR-based vaccination status.
Methods: This study was conducted in the Vaccine Safety Datalink, a network of 8 large medical care organizations in the United States.
Article Synopsis
- The study aimed to monitor trends in undervaccination among children due to parental vaccine refusal or delay to bolster public health responses.
- Conducted using data from the Vaccine Safety Datalink, the analysis revealed an increase in fully vaccinated children from 47.1% in 2008 to 68.4% in 2017, while the percentage of completely unvaccinated children also rose.
- The findings highlight an improvement in vaccination timeliness over 14 years, yet the growing number of children receiving no vaccines by 23 months calls for further public health intervention.
Article Synopsis
- Continuing medical education (CME) programs assess how committed healthcare professionals are to changing their practices, but there’s limited evidence on whether this commitment leads to actual changes in behavior.
- In a study focused on promoting proper antibiotic use for children with urinary tract infections (UTIs) through CME and updates to electronic health records, researchers evaluated participants' commitments and their prescribing habits over time.
- Results showed that clinicians who explicitly committed to changing their antibiotic prescriptions not only reported making those changes but also demonstrated significant improvements in prescribing practices, indicating that self-commitment can positively influence clinical behavior.
Objectives: To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings.
Methods: The study was conducted at Kaiser Permanente Colorado, a large health care organization with ∼127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs.
Objective: Clinical specialty societies recommend long-acting reversible contraceptives (LARCs) as first-line contraception for adolescent women. We evaluated whether a combined educational and process improvement intervention enhanced LARC placement in primary care within an integrated health care system.
Methods: The intervention included journal clubs, live continuing education, point-of-care guidelines, and new patient materials.
Estimating Childhood Obesity Prevalence in Communities Through Multi-institutional Data Sharing.
J Public Health Manag Pract
August 2021
Context: Although local childhood obesity prevalence estimates would be valuable for planning and evaluating obesity prevention efforts in communities, these data are often unavailable.
Objective: The primary objective was to create a multi-institutional system for sharing electronic health record (EHR) data to produce childhood obesity prevalence estimates at the census tract level. A secondary objective was to adjust obesity prevalence estimates to population demographic characteristics.
Article Synopsis
- The study aimed to investigate how different anticholinergic medication ratings affect the overall anticholinergic score and its link to falls in older adults with cognitive impairments.
- It analyzed data from over 10,000 individuals aged 65 and older using the anticholinergic cognitive burden (ACB) scale to quantify medication use and incidents of falls or injuries over a median follow-up period of approximately one year.
- Results indicated that combinations of higher-rated anticholinergic drugs (level 2 and 3) significantly increased the risk of falls compared to lower-rated (level 1) drugs, highlighting that the same ACB score can represent varying levels of fall risk based on drug ratings.
Background: Primary prevention implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients with left ventricular systolic dysfunction by delivering therapies (antitachycardia pacing or shocks) to terminate potentially lethal arrhythmias; inappropriate therapies also occur. We assessed device therapies among adults receiving primary prevention ICDs in 7 healthcare systems.
Methods And Results: We linked medical record data, adjudicated device therapies, and the National Cardiovascular Data Registry ICD Registry.
Background: Drugs with anticholinergic properties are considered potentially inappropriate in patients with cognitive impairment because harms-including delirium, falls, and fractures-may outweigh benefits.
Objective: To highlight opportunities to improve clinical decision making and care for patients with cognitive impairment and multiple chronic conditions, we identified distinct subgroups of patients with mild cognitive impairment (MCI) and dementia who had high cumulative anticholinergic burden and specific patterns of anticholinergic use.
Patients And Methods: We conducted a retrospective cohort study in a not-for-profit, integrated delivery system.
Article Synopsis
- - A study aimed to create a model to predict hypertension risk in children with newly elevated blood pressure, using data from Kaiser Permanente Colorado and validating it through two other organizations.
- - The research found that out of 5,598 children with elevated BP, about 2.9% developed hypertension, with several demographic and clinical factors identified as predictors of risk.
- - While the model performed well in its original setting, it showed poor accuracy when applied to other sites, indicating a limitation in its applicability to different populations.
Article Synopsis
- A study examined adverse outcomes in 2,954 patients with low left ventricular ejection fraction receiving implantable cardioverter-defibrillators (ICDs) for primary prevention, focusing on the influence of sex and age on mortality and hospitalization rates.
- Results showed that women had lower risks for death and heart failure hospitalizations but higher complication rates compared to men, while those over 65 had increased risks of both death and heart failure hospitalizations.
- The findings highlight significant disparities in outcomes based on sex and age, emphasizing the need for tailored approaches in treating patients receiving ICDs.
Background: Cancer patients with cardiovascular and other comorbidities are at concurrent risk of multiple adverse outcomes. However, most treatment decisions are guided by evidence from single-outcome models, which may be misleading for multimorbid patients.
Objective: We assessed the interacting effects of cancer, cardiovascular, and other morbidity burdens on the competing outcomes of cancer mortality, serious cardiovascular events, and other-cause mortality.
Article Synopsis
- The study investigates the opioid use in obese patients who were chronic opioid users before undergoing bariatric surgery and whether their usage changes post-surgery.
- It involves a retrospective analysis of 11,719 patients from varied U.S. health systems, assessing opioid consumption one year before and after the procedure, excluding the first 30 days post-surgery.
- Results show that a significant majority (77%) of chronic opioid users continued their usage after surgery, with a slight increase in average daily morphine equivalents, and the degree of body mass index reduction did not significantly impact changes in opioid use.
Article Synopsis
- The study aimed to evaluate how pediatric care responds to children with elevated blood pressure (BP) by assessing the timing of follow-up measurements and the likelihood of those children continuing to have high BP.
- Out of over 72,000 children studied, only 8.4% experienced an incident of elevated BP, and only 20.9% had a follow-up measurement within a month.
- Although most children did not get timely follow-up BP checks, very few (1.4%) continued to have consistently elevated BP within a year, indicating that most cases may not progress to hypertension.
Article Synopsis
- The study investigates statin prescribing habits among patients with life-limiting illnesses, specifically comparing those on statins for secondary prevention of cardiovascular disease versus those on them for primary prevention.
- Researchers analyzed data from 539 individuals diagnosed with cancer and observed that around 58% of those on secondary prevention and 62% on primary prevention continued refilling their statin prescriptions after diagnosis.
- The findings suggest that while both groups had similar refill patterns and timing, there's a need to assess the necessity of continued statin use for primary prevention, especially given the patients' limited life expectancy.
Longitudinal study of implantable cardioverter-defibrillators: methods and clinical characteristics of patients receiving implantable cardioverter-defibrillators for primary prevention in contemporary practice.
Circ Cardiovasc Qual Outcomes
November 2012
Background: Implantable cardioverter-defibrillators (ICDs) are increasingly used for primary prevention after randomized, controlled trials demonstrating that they reduce the risk of death in patients with left ventricular systolic dysfunction. The extent to which the clinical characteristics and long-term outcomes of unselected, community-based patients with left ventricular systolic dysfunction undergoing primary prevention ICD implantation in a real-world setting compare with those enrolled in the randomized, controlled trials is not well characterized. This study is being conducted to address these questions.
View Article and Find Full Text PDFObjectives: Crotalidae polyvalent immune Fab (ovine) (FabAV) is commonly used in the treatment of symptomatic North American crotaline snake envenomation. When approved by the U.S.
View Article and Find Full Text PDFArticle Synopsis
- Prescription monitoring programs (PMPs) are state-run databases that help track prescription drug use to identify potential abuse or illegal activities, aimed at reducing prescription drug misuse.
- A study analyzed data from two surveillance systems to assess the impact of PMPs on opioid misuse trends between 2003 and 2009, using statistical methods to compare states with and without PMPs.
- Results indicated that states with PMPs experienced lower rates of opioid abuse and misuse, suggesting that PMPs are beneficial, but further research is needed to determine the most effective characteristics of these programs.