National health care infrastructures, health care utilization and patient movements between hospitals: Networks working to improve surveillance




Research Network: 2019-04-01 - 2020-06-30
Total sum awarded: €50 000

There is a worldwide concern about the emergence, and widespread dissemination, of AMR “high risk” clones that carry the genomic determinants for enhanced virulence and resistance. Regional, national and international surveillance is considered an important component in a strategy to control these strains. However, current surveillance systems are not fit for this purpose and there is still no good evidence base for deciding which and how many sentinel hospitals should be included in surveillance programs. Previous work coordinated by the coordinator has shown that AMR “high-risk” clones spread between health care institutions as a result of patient movements. Hospitals thus become connected by patients. Taken together, all connections create a nexus of institutions that can be described as national health care referral networks. Despite their apparent complexity, these networks reveal a simple scaffolding and remarkably consistent properties that lie at the core of national health care infrastructures. These show many of the typical hallmarks of hierarchically distributed networks, with regionality, centrality, scale-freeness and small world properties. Hence a quantitative understanding of the network dynamics offers the means for purpose-designed surveillance and better targeted interventions. The current proposal will bring together a critical mass of public health microbiologists, health systems researchers, and social network analysts from Europe and beyond. These experts will define the data needs, data sources, algorithms and analysis tools with the aim to identify a heuristic optimisation approach to sentinel site selection. In this way the suggested network activities will provide recommendations for the development of surveillance structures that are more parsimonious, cost- and time effective and provide—through the selection of sampling sites for genomic surveillance by whole genome sequencing (WGS)—the genetic signatures for early, next generation diagnostics of recently emerging clones. The focus on site selection means that WGS will not be part of this initiative.

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  • Hajo Grundmann, University of Freiberg, Germany (Coordinator)
  • Gunnar Skov Simonsen, University Hospital Tromsø, Norway (Observer)
  • Waleria Hryniewicz, National Medicines Institute, Poland (Observer)
  • Jesus Oteo Iglesias, Spanish Reference Laboratory for Antibiotic Resistance, Spain (Observer)
  • Christian Giske, Karolinska Institutet, Sweden (Observer)
  • Neil Woodford, Public Health England, United Kingdom (Observer)
  • Jacqui Reilly, Health Protection Scotland, United Kingdom (Observer)
  • Tjibbe Donker, NIHR Global Health Research Unit, United Kingdom (Observer)
  • Josephina Campos, Administración Nacional de Laboratorios e Institutos de Salud, Argentina (Observer)
  • Herman Goossens, University of Antwerp, Belgium (Observer)
  • Helena Zemlickova, Charles University, Czech Republic (Observer)
  • Laura Temime, Conservatoire National des Arts et Métiers, France (Observer)
  • Petra Gastmeier, Charité University Medicine, Germany (Observer)
  • Balázs Babarczy, National Healthcare Service Center, Hungary (Observer)
  • Patrizio Pezotti, Istituto Superiore di Sanità, Italy (Observer)
  • Maria Luisa Moro, Health and Social Agency Emilia, Italy (Observer)
  • Alex Friedrich, University Medical Center Groningen, Netherlands (Observer)