Understanding E.Coli-Antimicrobial Resistance (AMR) from Systems Thinking and System Dynamics Perspective

Increasing E. Coli - AMR cases in hospitals have been a major healthcare concern in many countries, especially the United Kingdom (UK). Although the current policies in the UK are helpful in early screening of hospital-onset E. Coli-AMR cases to prevent the complications like death at the hospital level, they are not proactive enough to bring down the rising cases in hospitals. This is because community-onset E. Coli-AMR cases have been overlooked – it is the community-onset cases that spread the infections within the country, eventually increasing hospitalization, hospital-onset cases, and serious complications. Hence, it is necessary for the policies to be proactive in addressing the issue at the community level (upstream), which can reduce hospital cases. This paper hypothesizes and validates a holistic model that captures the interconnections within and between hospital and community sectors using a revised Systems Thinking / System Dynamics (ST/SD) modelling methodology. The revised method helped reduce the number of parameters in the hypothesized model from 22 to 4 and identify key leverage points in the system. A preliminary model-based policy evaluation has been performed targeting the leverage points that would bring down the E.Coli-AMR cases