Social robot-based solution for elders’ Care management and coaching after discharge from Hospital to Home

The overall goal of H2Hcare was to support seniors with heart failure in their transition from acute (hospital) to community (home) care by providing assistant-based coaching for helping them to deal with post discharge recommended treatment plan and lifestyle changes. This has included to: Enable a proper care support network to reduce patient anxiety or worries and to offer coaching support for patients during convalescence, Enable patients and family caregivers to optimize self-management in recovery and reduce incidents of hospital readmission, Support patient in adherence to post-discharge instructions, e.g. medication usage or behavioral changes, and Support the health professionals providing monitoring and follow-up, leading to better care and reduced prolonging hospitalization. H2HCare has provided a holistic approach to transitional care based on integrating sensors, ICT techniques and digital assistant technologies to bridge the care gap of patient transition from acute setting back into the community. H2HCare differentiate with respect to current solutions in terms of whole person longitudinal assessment to appropriately assess readmission risks and configure the digital assistant care solution accordingly, remote monitoring of compliance to the post discharge treatment plan and lifestyle changes recommendations and coaching to increase quality of self treatment and reduce re-hospitalization..H2HCare adopted a user-centred development methodology involving relevant end-users through all phases The project is funded by EU Ambient Assisted Living Research Program and the Norwegian Research council. It includes three Norwegian partners; Tellu IoT AS, No Isolation AS and Seniornett Norge. The Technical University of Cluj-Napoca (Romania) has been the project leader, and the University Hospitals of Geneva, (Switzerland) has performed evaluations and field studies .

H2HCare have developed and integrate novel social digital couch technologies, with artificial intelligence and AAL solutions to holistically address the needs of elders with heart failure during transitional care process and avoid hospital readmission. This includes technologies and tools to: (1) Assess the elderly patients prior to discharge by stratifying the lifestyle risks of needing hospital readmissions (2) Provide personalized treatment plans and lifestyle changes recommendations to address identified hospital readmission risks; (3) Monitor daily life activities remotely to check the adherence to post-discharge lifestyle changes recommendations and treatment, by integrating IoT sensors and AI; (4) Provide personalized coaching and motivation at home using KOMP/AV1 social digital assistant, to facilitate the implementation of post-discharge lifestyle changes recommendations and treatment plan; (5) Ensure direct communication through the digital assistant between the patients and other actors of the healthcare chain

H2HCare will provide a holistic approach to transitional care based on integrating sensors, ICT techniques and social robotics/digital assistant to bridge the care gap of patient transition from acute setting back into the community. H2HCare has key selling points that differentiate it in the market and make it appealing to the target customers: (i) patient predischarge whole person longitudinal assessment to appropriately assess readmission risks and configure the digital assistant care solution; (ii) older adult post-discharge remote monitoring of compliance to the post discharge treatment plan and lifestyle changes recommendations and (iii) robot/digital assistant based coaching to increase seniors’ adherence and non-face to face follow-ups using virtual meetings. The Norwegian cluster encompass about half of total project resources and will significantly contribute to all objectives and subobjectives and all Work Packages. In particular NoIsolation and Tellu will work on the development of the robot/digital assistant that will be the central information and communication hub of the H2HCare solution and the central , including the sensor integration and monitoring as well as the coaching. Seniornett will in particular take part in requirements and evaluation tasks in the project PRIMARY users are older adults with heart failure that typically have frequent hospitalization, are living independently, can be male or female, typically over 65 years, are in need of care assistance to avoid rehospitalization, SECONDARY users are doctors (hospital and community doctors), and formal & informal caregivers; TERTIARY users are healthcare organizations involved in elderly transitional care process (i.e. emergency and ambulatory departments, hospital wards, etc.). H2HCare will adopt a user-centred development methodology involving relevant end-users through all phases: co-design and implementation, testing and validation and business modelling.