The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system.

OBJECTIVE As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare 'ecosystem' in infection control. MATERIALS AND METHODS We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases. RESULTS To demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity). DISCUSSION Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities. CONCLUSIONS A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions.

[1]  Shawn T. Brown,et al.  The Potential Regional Impact of Contact Precaution Use in Nursing Homes to Control Methicillin-Resistant Staphylococcus aureus , 2013, Infection Control & Hospital Epidemiology.

[2]  Shawn T. Brown,et al.  Simulation shows hospitals that cooperate on infection control obtain better results than hospitals acting alone. , 2012, Health affairs.

[3]  Y. Wang,et al.  Modelling the transmission dynamics of meticillin-resistant Staphylococcus aureus in Beijing Tongren hospital. , 2011, The Journal of hospital infection.

[4]  B. Golden,et al.  Contribution of Interfacility Patient Movement to Overall Methicillin-Resistant Staphylococcus aureus Prevalence Levels , 2011, Infection Control & Hospital Epidemiology.

[5]  Richard Platt,et al.  Social network analysis of patient sharing among hospitals in Orange County, California. , 2011, American journal of public health.

[6]  G. Kang,et al.  Transmission Dynamics of Methicillin-Resistant Staphylococcus aureus in a Medical Intensive Care Unit in India , 2011, PloS one.

[7]  Kimberly A. Reske,et al.  Epidemiological Model for Clostridium difficile Transmission in Healthcare Settings , 2011, Infection Control & Hospital Epidemiology.

[8]  Lorenzo Milazzo,et al.  Modelling of Healthcare Associated Infections: A study on the dynamics of pathogen transmission by using an individual-based approach , 2011, Computer Methods and Programs in Biomedicine.

[9]  J. Raboud,et al.  Effect of Patterns of Transferring Patients among Healthcare Institutions on Rates of Nosocomial Methicillin-Resistant Staphylococcus aureus Transmission: A Monte Carlo Simulation , 2011, Infection Control & Hospital Epidemiology.

[10]  S. Frank,et al.  Quantifying Interhospital Patient Sharing as a Mechanism for Infectious Disease Spread , 2010, Infection Control & Hospital Epidemiology.

[11]  P. Vanhems,et al.  Modeling Nosocomial Transmission of Rotavirus in Pediatric Wards , 2010, Bulletin of mathematical biology.

[12]  Jacco Wallinga,et al.  Patient Referral Patterns and the Spread of Hospital-Acquired Infections through National Health Care Networks , 2010, PLoS Comput. Biol..

[13]  R. Holman,et al.  Methicillin-resistant Staphylococcus aureus-associated hospitalizations among the American Indian and Alaska native population. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  J. Gerber,et al.  Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children's hospitals in the United States. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  C C Drovandi,et al.  Multivariate Markov Process Models for the Transmission of Methicillin‐Resistant Staphylococcus Aureus in a Hospital Ward , 2008, Biometrics.

[16]  Bruce Y. Lee,et al.  Digital decision making: computer models and antibiotic prescribing in the twenty-first century. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  N. Masuda,et al.  Controlling nosocomial infection based on structure of hospital social networks , 2008, Journal of Theoretical Biology.

[18]  Hugo Sax,et al.  Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. , 2008, JAMA.

[19]  J. Robotham,et al.  Meticillin-resistant Staphylococcus aureus (MRSA) in hospitals and the community: model predictions based on the UK situation. , 2007, The Journal of hospital infection.

[20]  A. Pettitt,et al.  A stochastic mathematical model of methicillin resistant Staphylococcus aureus transmission in an intensive care unit: predicting the impact of interventions. , 2007, Journal of theoretical biology.

[21]  Richard Platt,et al.  Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. , 2007, The Journal of infectious diseases.

[22]  L. McCaig,et al.  Staphylococcus aureus–associated Skin and Soft Tissue Infections in Ambulatory Care , 2006, Emerging infectious diseases.

[23]  S. Solomon,et al.  Methicillin-resistant–Staphylococcus aureus Hospitalizations, United States , 2005, Emerging infectious diseases.

[24]  David L. Smith,et al.  Strategic interactions in multi-institutional epidemics of antibiotic resistance. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[25]  B. Cooper,et al.  Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[26]  David L. Smith,et al.  Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: resistance is a regional problem. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[27]  Long Beach Marriott Hotel,et al.  Office of Statewide Health Planning and Development , 2008 .