Quantifying interhospital patient sharing as a mechanism for infectious disease spread.

BACKGROUND: Assessments of infectious disease spread in hospitals seldom account for interfacility patient sharing. This is particularly important for pathogens with prolonged incubation periods or carrier states. METHODS: We quantified patient sharing among all 32 hospitals in Orange County (OC), California, using hospital discharge data. Same-day transfers between hospitals were considered "direct" transfers, and events in which patients were shared between hospitals after an intervening stay at home or elsewhere were considered "indirect" patient-sharing events. We assessed the frequency of readmissions to another OC hospital within various time points from discharge and examined interhospital sharing of patients with Clostridium difficile infection. RESULTS: In 2005, OC hospitals had 319,918 admissions. Twenty-nine percent of patients were admitted at least twice, with a median interval between discharge and readmission of 53 days. Of the patients with 2 or more admissions, 75% were admitted to more than 1 hospital. Ninety-four percent of interhospital patient sharing occurred indirectly. When we used 10 shared patients as a measure of potential interhospital exposure, 6 (19%) of 32 hospitals "exposed" more than 50% of all OC hospitals within 6 months, and 17 (53%) exposed more than 50% within 12 months. Hospitals shared 1 or more patient with a median of 28 other hospitals. When we evaluated patients with C. difficile infection, 25% were readmitted within 12 weeks; 41% were readmitted to different hospitals, and less than 30% of these readmissions were direct transfers. CONCLUSIONS: In a large metropolitan county, interhospital patient sharing was a potential avenue for transmission of infectious agents. Indirect sharing with an intervening stay at home or elsewhere composed the bulk of potential exposures and occurred unbeknownst to hospitals.

Using Geographic Information Systems to Define and Map Commuting Patterns as Inputs to Agent-Based Models.

By understanding the movement patterns of people, mathematical modelers can develop models that can better analyze and predict the spread of infectious diseases. People can come into close contact in their workplaces. This report describes methods to develop georeferenced commuting patterns that can be used to characterize the work-related movement of US populations and help agent-based modelers predict workplace contacts that result in disease transmission. We used a census data product called "Census Spatial Tabulation: Census Track of Work by Census Tract of Residence (STP64)" as the data source to develop commuting pattern data for agent-based synthesized populations databases and to develop map products to visualize commuting patterns in the United States. The three primary maps we developed show inbound, outbound, and net change levels of inbound versus outbound commuters by census tract for the year 2000. Net change counts of commuters are visualized as elevations. The results can be used to quantify and assign commuting patterns of synthesized populations among different census tracts.