Web-Based Interactive Tool to Identify Facilities at Risk of Receiving Patients With Multidrug-Resistant Organisms

Rany Octaria; Allison Chan; Hannah Wolford; Rose Devasia; Troy D. Moon; Yuwei Zhu; Rachel B. Slayton; Marion A. Kainer


Emerging Infectious Diseases. 2020;26(9):2046-2053. 

In This Article


The Shiny web application includes facility-level patient sharing data from the 2014–2017 HDDS dataset and Medicare datasets from 2014 and 2016. Both data sources had 3 networks for each transfer interval: direct, 30, and 365 days. The 2017 HDDS network included a total of 146 hospitals of 4 types; 116 ACH, 13 CAH, 9 IRF, and 8 LTACH. In 2017, the HDDS dataset recorded 886,277 inpatient hospitalizations representing 494,153 patients. Among patients discharged from Tennessee hospitals in 2017, a total of 29.5% (145,953) were readmitted to another Tennessee hospital within 365 days. The median interval of time in the community was 46 (IQR 11–109) days; 13.8% of patients who were readmitted to a different hospital were directly transferred.

The 2016 CMS dataset reported 381,627 stays to 465 Tennessee facilities representing 196,528 unique patients. These 465 facilities included 91 ACHs, 16 CAH, 10 LTACHs, 10 IRFs, 322 SNFs, 1 children's hospital, and 15 psychiatric hospitals, as classified by the CMS certification numbers. Among all admissions to a Tennessee facility, 82.9% (316,368) of patients had a previous healthcare admission within 365 days; 29.9% of those readmissions were a direct transfer from a healthcare facility. The median interval of time in the community was 11 (IQR 0–108) days. Our downstream facility analysis showed that among the 5 randomly selected facilities, 84% (range 80%–88%) of the facilities in the top 5 from the prior year were in the top 5 again in the succeeding year (Appendix, https://wwwnc.cdc.gov/EID/article/26/9/19-1691-App1.xlsx).