Understanding and preventing the spread of both endemic and emerging healthcare-associated infectious diseases throughout hospitals and nursing homes is a national priority. Our work has shown that the many disparate inpatient healthcare facilities in a region can form a complex healthcare ecosystem connected by both direct and indirect patient sharing allowing pathogens in one health care facility to readily spread to other facilities. Our goal is to further develop RHEA (Regional Healthcare Ecosystem Analyst) into a user-friendly software tool that decision makers (e.g., policy makers, funders, product developers and manufacturers, healthcare administrators, infection prevention specialists, researchers, and educators) can readily use to help healthcare ecosystems prevent and control the spread of an endemic pathogen, methicillin- resistant Staphylococcus aureus (MRSA), and an emerging pathogen, carbapenem-resistant Enterobacteriaceae (CRE). This next generation of RHEA will bring multiple innovations by: 1) further elucidating the interconnectedness of the ecosystem and showcasing the value of cooperation among facilities versus the current individual facility approach to infectious disease control, 2) incorporating new healthcare ecosystem responses for endemic MRSA and emerging CRE, 3) continuing our work integrating economic and operational models into a framework of infectious disease epidemiological models, 4) imbuing virtual patients with characteristics linked to MRSA and CRE transmission and outcome risk, 5) building a comprehensive """"""""virtual laboratory"""""""" to help address many existing and future healthcare ecosystem infectious disease questions, and 6) building a user-friendly modeling tool that decision makers can use. The project will continue our team's longstanding modeling work and developing computational tools for decision makers via three specific aims. First, completing Specific Aim 1 will expand RHEA by adding the following capabilities: i) integrated clinical outcome and economic models, ii) more extensive and detailed patient characteristics linked to changes in infection risk and costs, iii) expanded HAI control measures, and iv) stochastic and adaptive disease parameters to represent emerging and evolving diseases. Next, Specific Aim 2 will use our newly expanded RHEA framework to model a sample endemic pathogen, MRSA, and a sample emerging pathogen, CRE to identify optimal control strategies even when pathogen characteristics are evolving. Finally, Specific Aim 3 will involve developing a user-friendly interface for RHEA and deploying it as a healthcare ecosystem computational modeling tool that various stakeholders (e.g., policy makers, healthcare administrators, infection control specialists, funders, and product manufacturers) can readily use to make decisions regarding the control of healthcare-associated infections.

Public Health Relevance

Understanding and preventing the spread of healthcare-associated infectious diseases throughout hospitals and nursing homes is a national priority. Simulation models can serve as virtual laboratories to help identify best practice solutions for containing common [such as methicillin-resistant Staphylococcus aureus (MRSA)] and emerging [e.g., carbapenem-resistant Enterobacteriaceae (CRE)] causes of healthcare associated infections (HAIs). Our goal is to develop our software RHEA (Regional Healthcare Ecosystem Analyst) into a computational modeling tool that can be used directly by decision makers to identify, develop, and evaluate strategies and interventions to reduce HAIs across a large geographic region.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
Project #
Application #
Study Section
Program Officer
Gray, Darryl T
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
Lee, Bruce Y; Bartsch, Sarah M; Wong, Kim F et al. (2016) Beyond the Intensive Care Unit (ICU): Countywide Impact of Universal ICU Staphylococcus aureus Decolonization. Am J Epidemiol 183:480-9
Bartsch, Sarah M; Huang, Susan S; Wong, Kim F et al. (2016) Impact of Delays between the Clinical and Laboratory Standards Institute (CLSI) and the Food and Drug Administration (FDA) Revising Interpretive Criteria for Carbapenem-Resistant Enterobacteriaceae (CRE). J Clin Microbiol :
Bartsch, Sarah M; Hotez, Peter J; Hertenstein, Daniel L et al. (2016) Modeling the economic and epidemiologic impact of hookworm vaccine and mass drug administration (MDA) in Brazil, a high transmission setting. Vaccine 34:2197-206
Bartsch, Sarah M; Lopman, Benjamin A; Ozawa, Sachiko et al. (2016) Global Economic Burden of Norovirus Gastroenteritis. PLoS One 11:e0151219
Mueller, Leslie E; Haidari, Leila A; Wateska, Angela R et al. (2016) The impact of implementing a demand forecasting system into a low-income country's supply chain. Vaccine 34:3663-9
Haidari, Leila A; Brown, Shawn T; Constenla, Dagna et al. (2016) The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique. Vaccine 34:4161-5
Lee, Bruce Y; Bartsch, Sarah M; Wong, Kim F et al. (2016) The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit. Am J Epidemiol 183:471-9
Lee, Bruce Y; Schreiber, Benjamin; Wateska, Angela R et al. (2015) The Benin experience: How computational modeling can assist major vaccine policy changes in low and middle income countries. Vaccine 33:2858-61
Norman, Bryan A; Rajgopal, Jayant; Lim, Jung et al. (2015) Modular vaccine packaging increases packing efficiency. Vaccine 33:3135-41
Lee, Bruce Y; Bartsch, Sarah M; Brown, Shawn T et al. (2015) Quantifying the economic value and quality of life impact of earlier influenza vaccination. Med Care 53:218-29

Showing the most recent 10 out of 15 publications