Post-surgery care involves ongoing collaboration between provider teams and patients, which starts from post-surgery hospitalization through home recovery after discharge. While prior HCI research has primarily examined patients' challenges at home, less is known about how provider teams coordinate discharge preparation and care handoffs, and how breakdowns in communication and care pathways may affect patient recovery. To investigate this gap, we conducted semi-structured interviews with 13 healthcare providers and 4 patients in the context of gastrointestinal (GI) surgery. We found coordination boundaries between in- and out-patient teams, coupled with complex organizational structures within teams, impeded the "invisible work" of preparing patients' home care plans and triaging patient information. For patients, these breakdowns resulted in inadequate preparation for home transition and fragmented self-collected data, both of which undermine timely clinical decision-making. Based on these findings, we outline design opportunities to formalize task ownership and handoffs, contextualize co-temporal signals, and align care plans with home resources.
Home-based care (HBC) delivers medical and care services in patients' living environments, offering unique opportunities for patient-centered care. However, patient agency is often inadequately represented in shared HBC planning processes. Through 23 multi-stakeholder interviews with HBC patients, healthcare professionals, and care workers, alongside 60 hours of ethnographic observations, we examined how patient agency manifests in HBC and why this representation gap occurs. Our findings reveal that patient agency is not a static individual attribute but a relational capacity shaped through maintaining everyday continuity, mutual recognition from care providers, and engagement with material home environments. Furthermore, we identified that structured documentation systems filter out contextual knowledge, informal communication channels fragment patient voices, and doctor-centered hierarchies position patients as passive recipients. Drawing on these insights, we propose design considerations to bridge this representation gap and to integrate patient agency into shared HBC plans.
Demand for older-adult and patient care is growing rapidly as populations age worldwide. Foundation models are increasingly being integrated into robots and interactive agents, with the promise of more flexible communication and personalized assistance. However, care settings require reliable and workflow-compatible systems with accountable human oversight, and it remains unclear whether current embodied systems can translate technical advances into clinical impact. This Perspective synthesizes foundation model-based care robots across three areas: design features, user experience, and evidence for care-related outcomes. Current systems most commonly use foundation models as conversational and reasoning layers within voice-centered socially assistive embodiments, while multimodal grounding and physical autonomy remain limited. Empirical evaluations report positive usability and engagement benefits, but reliability failures persist across the interaction pipeline such as hallucinations and conversational breakdowns. Evidence for care impact remains concentrated in proximal outcomes such as cognitive engagement and participation, with limited evidence for validated clinical or care-r
Objetive: In the care of renal patients, prioritising their quality of life and nursing care is essential. Research links patients' perceptions of care quality to improved outcomes such as safety, clinical efficacy, treatment adherence, and preventive practices. This study aimed to evaluate the quality of life and care perception in these patients and explore potential associations between these dimensions. Material and methods: A cross-sectional descriptive study was conducted with 43 patients attending an advanced CKD clinic. Quality of life was assessed using the KDQOL-36 questionnaire, while the IECPAX questionnaire measured perceived care quality. Sociodemographic and clinical data were collected from patient records. Participants completed the questionnaires during routine visits, with scores analysed to identify associations between variables. Results: The study included 60% men (n=28) and 32% women (n=15), with a mean age of 78 years . Among participants, 45% were diabetic, 79% hypertensive, and 58% took more than five medications daily. Mean scores were 78.76 for KDQOL-36 and 5.54 for IECPAX. Significant differences were found in the physical role domain between men and wo
Chronic diseases constitute the principal burden of morbidity, mortality, and healthcare costs worldwide, yet current health systems remain fragmented and predominantly reactive. Patient Medical Digital Twins (PMDTs) offer a paradigm shift: holistic, continuously updated digital counterparts of patients that integrate clinical, genomic, lifestyle, and quality-of-life data. We report early implementations of PMDTs via ontology-driven modeling and federated analytics pilots. Insights from the QUALITOP oncology study and a distributed AI platform confirm both feasibility and challenges: aligning with HL7 FHIR and OMOP standards, embedding privacy governance, scaling federated queries, and designing intuitive clinician interfaces. We also highlight technical gains, such as automated reasoning over multimodal blueprints and predictive analytics for patient outcomes. By reflecting on these experiences, we outline actionable insights for software engineers and identify opportunities, such as DSLs and model-driven engineering, to advance PMDTs toward trustworthy, adaptive chronic care ecosystems.
Demand for health care is constantly increasing due to the ongoing demographic change, while at the same time health service providers face difficulties in finding skilled personnel. This creates pressure on health care systems around the world, such that the efficient, nationwide provision of primary health care has become one of society's greatest challenges. Due to the complexity of health care systems, unforeseen future events, and a frequent lack of data, analyzing and optimizing the performance of health care systems means tackling a wicked problem. To support this task for primary care, this paper introduces the hybrid agent-based simulation model SiM-Care. SiM-Care models the interactions of patients and primary care physicians on an individual level. By tracking agent interactions, it enables modelers to assess multiple key indicators such as patient waiting times and physician utilization. Based on these indicators, primary care systems can be assessed and compared. Moreover, changes in the infrastructure, patient behavior, and service design can be directly evaluated. To showcase the opportunities offered by SiM-Care and aid model validation, we present a case study for
The rising prevalence of chronic wounds, especially in aging populations, presents a significant healthcare challenge due to prolonged hospitalizations, elevated costs, and reduced patient quality of life. Traditional wound care is resource-intensive, requiring frequent in-person visits that strain both patients and healthcare professionals (HCPs). Therefore, we present WoundAIssist, a patient-centered, AI-driven mobile application designed to support telemedical wound care. WoundAIssist enables patients to regularly document wounds at home via photographs and questionnaires, while physicians remain actively engaged in the care process through remote monitoring and video consultations. A distinguishing feature is an integrated lightweight deep learning model for on-device wound segmentation, which, combined with patient-reported data, enables continuous monitoring of wound healing progression. Developed through an iterative, user-centered process involving both patients and domain experts, WoundAIssist prioritizes an user-friendly design, particularly for elderly patients. A conclusive usability study with patients and dermatologists reported excellent usability, good app quality,
Despite a growing need for spiritual care in the US, it is often under-served, inaccessible, or misunderstood, while almost no prior work in CSCW/HCI research has engaged with professional chaplains and spiritual care providers. This interdisciplinary study aims to develop a foundational understanding of how spiritual care may (or may not) be expanded into online spaces -- especially focusing on anonymous, asynchronous, and text-based online communities. We conducted an exploratory mixed-methods study with chaplains (N=22) involving interviews and user testing sessions centered around Reddit support communities to understand participants' perspectives on technology and their ideations about the role of chaplaincy in prospective Online Spiritual Care Communities (OSCCs). Our Grounded Theory Method analysis highlighted benefits of OSCCs including: meeting patients where they are at; accessibility and scalability; and facilitating patient-initiated care. Chaplains highlighted how their presence in OSCCs could help with shaping peer interactions, moderation, synchronous chats for group care, and redirecting to external resources, while also raising important feasibility concerns, risks
COVID-19 has caused an enormous burden on healthcare facilities around the world. Cohorting patients and healthcare professionals (HCPs) into "bubbles" has been proposed as an infection-control mechanism. In this paper, we present a novel and flexible model for clustering patient care in healthcare facilities into bubbles in order to minimize infection spread. Our model aims to control a variety of costs to patients/residents and HCPs so as to avoid hidden, downstream adverse effects of clustering patient care. This model leads to a discrete optimization problem that we call the BubbleClustering problem. This problem takes as input a temporal visit graph, representing HCP mobility, including visits by HCPs to patient/resident rooms. The output of the problem is a rewired visit graph, obtained by partitioning HCPs and patient rooms into bubbles and rewiring HCP visits to patient rooms so that patient-care is largely confined to the constructed bubbles. Even though the BubbleClustering problem is intractable in general, we present an integer linear programming (ILP) formulation of the problem that can be solved optimally for problem instances that arise from typical hospital units an
Intensive Care Units (ICU) provide close supervision and continuous care to patients with life-threatening conditions. However, continuous patient assessment in the ICU is still limited due to time constraints and the workload on healthcare providers. Existing patient assessments in the ICU such as pain or mobility assessment are mostly sporadic and administered manually, thus introducing the potential for human errors. Developing Artificial intelligence (AI) tools that can augment human assessments in the ICU can be beneficial for providing more objective and granular monitoring capabilities. For example, capturing the variations in a patient's facial cues related to pain or agitation can help in adjusting pain-related medications or detecting agitation-inducing conditions such as delirium. Additionally, subtle changes in visual cues during or prior to adverse clinical events could potentially aid in continuous patient monitoring when combined with high-resolution physiological signals and Electronic Health Record (EHR) data. In this paper, we examined the association between visual cues and patient condition including acuity status, acute brain dysfunction, and pain. We leveraged
Patient healthcare utilization consists of irregularly time-stamped events, such as outpatient visits, inpatient admissions, and emergency encounters, forming individualized care trajectories. Modeling these trajectories is crucial for understanding utilization patterns and predicting future care needs, but is challenging due to temporal irregularity and severe class imbalance. In this work, we build on the Transformer Hawkes Process framework to model patient trajectories in continuous time. By combining Transformer-based history encoding with Hawkes process dynamics, the model captures event dependencies and jointly predicts event type and time-to-event. To address extreme imbalance, we introduce an imbalance-aware training strategy using inverse square-root class weighting. This improves sensitivity to rare but clinically important events without altering the data distribution. Experiments on real-world data demonstrate improved performance and provide clinically meaningful insights for identifying high-risk patient populations.
End-stage renal disease patients face a complicated sociomedical situation and rely on various forms of infrastructure for life-sustaining treatment. Disruption of these infrastructures during disasters poses a major threat to their lives. To improve patient access to dialysis treatment, there is a need to assess the potential threat to critical care facilities from hazardous events. In this study, we propose optimization models to solve critical care system resilience problems including patient and medical resource allocation. We use human mobility data in the context of Harris County (Texas) to assess patient access to critical care facilities, dialysis centers in this study, under the simulated hazard impacts, and we propose models for patient re-allocation and temporary medical facility placement to improve critical care system resilience in an equitable manner. The results show (1) the capability of the optimization model in efficient patient re-allocation to alleviate disrupted access to dialysis facilities; (2) the importance of large facilities in maintaining the functioning of the system. The critical care system, particularly the network of dialysis centers, is heavily re
Relationship-centred care (RCC) recognises that healthcare quality depends not only on outcomes, but on how voice, responsibility, and emotional labour are negotiated among patients, caregivers, and providers. As AI systems enter sensitive care contexts, they introduce a new participant into these negotiations. Drawing on empirical work in Advance Care Planning (ACP) and peer support, we argue that AI's primary impact in high-subjectivity domains is not optimisation but redistribution: it reorganises who speaks, who decides, and who bears moral responsibility. Across both settings, participants were less concerned with technical accuracy than with relational consequences: whether AI would appropriately represent their decision, reduce burden, or blur accountability, scaffold connection, or subtly displace it. We identify three relational dimensions: authority, temporality, and visibility, through which AI reshapes care relationships, and propose design provocations centred on relational legibility, bounded agency, responsibility traceability, and non-substitutive scaffolding.
For patients undergoing systemic cancer therapy, the time between clinic visits is full of uncertainties and risks of unmonitored side effects. To bridge this gap in care, we developed and prospectively trialed a multi-modal AI framework for remote patient monitoring (RPM). This system integrates multi-modal data from the HALO-X platform, such as demographics, wearable sensors, daily surveys, and clinical events. Our observational trial is one of the largest of its kind and has collected over 2.1 million data points (6,080 patient-days) of monitoring from 84 patients. We developed and adapted a multi-modal AI model to handle the asynchronous and incomplete nature of real-world RPM data, forecasting a continuous risk of future adverse events. The model achieved an accuracy of 83.9% (AUROC=0.70). Notably, the model identified previous treatments, wellness check-ins, and daily maximum heart rate as key predictive features. A case study demonstrated the model's ability to provide early warnings by outputting escalating risk profiles prior to the event. This work establishes the feasibility of multi-modal AI RPM for cancer care and offers a path toward more proactive patient support.(Ac
For centuries nursing has been known as a job that requires complex manual operations, that cannot be automated or replaced by any machinery. All the devices and techniques have been invented only to support, but never fully replace, a person with knowledge and expert intuition. With the rise of Artificial Intelligence and continuously increasing digital data flow in healthcare, new tools have arrived to improve patient care and reduce the labour-intensive work conditions of a nurse. This cross-disciplinary review aims to build a bridge over the gap between computer science and nursing. It outlines and classifies the methods for machine learning and data processing in patient care before and after the operation. It comprises of Process-, Patient-, Operator-, Feedback-, and Technology-centric classifications. The presented classifications are based on the technical aspects of patient case.
Personalized chronic care requires the integration of multimodal health data to enable precise, adaptive, and preventive decision-making. Yet most current digital twin (DT) applications remain organ-specific or tied to isolated data types, lacking a unified and privacy-preserving foundation. This paper introduces the Patient Medical Digital Twin (PMDT), an ontology-driven in silico patient framework that integrates physiological, psychosocial, behavioral, and genomic information into a coherent, extensible model. Implemented in OWL 2.0, the PMDT ensures semantic interoperability, supports automated reasoning, and enables reuse across diverse clinical contexts. Its ontology is structured around modular Blueprints (patient, disease and diagnosis, treatment and follow-up, trajectories, safety, pathways, and adverse events), formalized through dedicated conceptual views. These were iteratively refined and validated through expert workshops, questionnaires, and a pilot study in the EU H2020 QUALITOP project with real-world immunotherapy patients. Evaluation confirmed ontology coverage, reasoning correctness, usability, and GDPR compliance. Results demonstrate the PMDT's ability to unify
As hospitals move towards automating and integrating their computing systems, more fine-grained hospital operations data are becoming available. These data include hospital architectural drawings, logs of interactions between patients and healthcare professionals, prescription data, procedures data, and data on patient admission, discharge, and transfers. This has opened up many fascinating avenues for healthcare-related prediction tasks for improving patient care. However, in order to leverage off-the-shelf machine learning software for these tasks, one needs to learn structured representations of entities involved from heterogeneous, dynamic data streams. Here, we propose DECENT, an auto-encoding heterogeneous co-evolving dynamic neural network, for learning heterogeneous dynamic embeddings of patients, doctors, rooms, and medications from diverse data streams. These embeddings capture similarities among doctors, rooms, patients, and medications based on static attributes and dynamic interactions. DECENT enables several applications in healthcare prediction, such as predicting mortality risk and case severity of patients, adverse events (e.g., transfer back into an intensive care
Urgent care clinics and emergency departments around the world periodically suffer from extended wait times beyond patient expectations due to inadequate staffing levels. These delays have been linked with adverse clinical outcomes. Previous research into forecasting demand this domain has mostly used a collection of statistical techniques, with machine learning approaches only now beginning to emerge in recent literature. The forecasting problem for this domain is difficult and has also been complicated by the COVID-19 pandemic which has introduced an additional complexity to this estimation due to typical demand patterns being disrupted. This study explores the ability of machine learning methods to generate accurate patient presentations at two large urgent care clinics located in Auckland, New Zealand. A number of machine learning algorithms were explored in order to determine the most effective technique for this problem domain, with the task of making forecasts of daily patient demand three months in advance. The study also performed an in-depth analysis into the model behaviour in respect to the exploration of which features are most effective at predicting demand and which
Emergency department (ED) overcrowding and patient boarding represent critical systemic challenges that compromise care quality. We propose a threshold-based admission policy that redirects non-urgent patients to alternative care pathways, such as telemedicine, during peak congestion. The ED is modeled as a two-class $M/M/c$ preemptive-priority queuing system, where high-acuity patients are prioritized and low-acuity patients are subject to state-dependent redirection. Analyzed via a level-dependent Quasi-Birth-Death (QBD) process, the model determines the optimal threshold by maximizing a long-run time-averaged objective function comprising redirection-affected revenue and costs associated with patient balking and system occupancy. Numerical analysis using national healthcare data reveals that optimal policies are highly context-dependent. While rural EDs generally optimize at lower redirection thresholds, urban EDs exhibit performance peaks at moderate thresholds. Results indicate that our optimal policy yields significant performance gains of up to $4.84\%$ in rural settings and $5.90\%$ in urban environments. This research provides a mathematically rigorous framework for balanc
In this paper we introduce novel Virtual Reality (VR) and Augmented Reality (AR) treatments to improve the psychological well being of patients in palliative care, based on interviews with a clinical psychologist who has successfully implemented VR assisted interventions on palliative care patients in the Hong Kong hospital system. Our VR and AR assisted interventions are adaptations of traditional palliative care therapies which simultaneously facilitate patients communication with family and friends while isolated in hospital due to physical weakness and COVID-19 related restrictions. The first system we propose is a networked, metaverse platform for palliative care patients to create customized virtual environments with therapists, family and friends which function as immersive and collaborative versions of 'life review' and 'reminiscence therapy'. The second proposed system will investigate the use of Mixed Reality telepresence and haptic touch in an AR environment, which will allow palliative care patients to physically feel friends and family in a virtual space, adding to the sense of presence and immersion in that environment.