搜索结果：Occupational therapy in health care

Post-deployment monitoring of artificial intelligence (AI) systems in health care is essential to ensure their safety, quality, and sustained benefit-and to support governance decisions about which systems to update, modify, or decommission. Motivated by these needs, we developed a framework for monitoring deployed AI systems grounded in the mandate to take specific actions when they fail to behave as intended. This framework, which is now actively used at Stanford Health Care, is organized around three complementary principles: system integrity, performance, and impact. System integrity monitoring focuses on maximizing system uptime, detecting runtime errors, and identifying when changes to the surrounding IT ecosystem have unintended effects. Performance monitoring focuses on maintaining accurate system behavior in the face of changing health care practices (and thus input data) over time. Impact monitoring assesses whether a deployed system continues to have value in the form of benefit to clinicians and patients. Drawing on examples of deployed AI systems at our academic medical center, we provide practical guidance for creating monitoring plans based on these principles that s

The health needs of those living in resource-limited settings are a vastly overlooked and understudied area in the intersection of machine learning (ML) and health care. While the use of ML in health care is more recently popularized over the last few years from the advancement of deep learning, low-and-middle income countries (LMICs) have already been undergoing a digital transformation of their own in health care over the last decade, leapfrogging milestones due to the adoption of mobile health (mHealth). With the introduction of new technologies, it is common to start afresh with a top-down approach, and implement these technologies in isolation, leading to lack of use and a waste of resources. In this paper, we outline the necessary considerations both from the perspective of current gaps in research, as well as from the lived experiences of health care professionals in resource-limited settings. We also outline briefly several key components of successful implementation and deployment of technologies within health systems in LMICs, including technical and cultural considerations in the development process relevant to the building of machine learning solutions. We then draw on

This review underscores the vital role of interoperability in digital health, advocating for a standardized framework. It focuses on implementing a Fast Healthcare Interoperability Resources (FHIR) server, addressing technical, semantic, and process challenges. FHIR's adaptability ensures uniformity within Primary Care Health Information Systems, fostering interoperability. Patient data management complexities highlight the pivotal role of semantic interoperability in seamless patient care. FHIR standards enhance these efforts, offering multiple pathways for data search. The ADR-guided FHIR server implementation systematically addresses challenges related to patient identity, biometrics, and data security. The detailed development phases emphasize architecture, API integration, and security. The concluding stages incorporate forward-looking approaches, including HHIMS Synthetic Dataset testing. Envisioning FHIR integration as transformative, it anticipates a responsive healthcare environment aligned with the evolving digital health landscape, ensuring comprehensive, dynamic, and interconnected systems for efficient data exchange and access.

The growing demand for home healthcare calls for tools that can support care delivery. In this study, we explore automatic health assessment from voice using real-world home care visit data, leveraging the diverse patient information it contains. First, we utilize Large Language Models (LLMs) to integrate Subjective, Objective, Assessment, and Plan (SOAP) notes derived from unstructured audio transcripts and structured vital signs into a holistic illness score that reflects a patient's overall health. This compact representation facilitates cross-visit health status comparisons and downstream analysis. Next, we design a multi-stage preprocessing pipeline to extract short speech segments from target speakers in home care recordings for acoustic analysis. We then employ an Audio Language Model (ALM) to produce plain-language descriptions of vocal biomarkers and examine their association with individuals' health status. Our experimental results benchmark both commercial and open-source LLMs in estimating illness scores, demonstrating their alignment with actual clinical outcomes, and revealing that SOAP notes are substantially more informative than vital signs. Building on the illness

Artificial intelligence (AI)-enabled digital interventions, including Generative AI (GenAI) and Human-Centered AI (HCAI), are increasingly used to expand access to digital psychiatry and mental health care. This PRISMA-ScR scoping review maps the landscape of AI-driven mental health (mHealth) technologies across five critical phases: pre-treatment (screening/triage), treatment (therapeutic support), post-treatment (remote patient monitoring), clinical education, and population-level prevention. We synthesized 36 empirical studies implemented through early 2024, focusing on Large Language Models (LLMs), machine learning (ML) models, and autonomous conversational agents. Key use cases involve referral triage, empathic communication enhancement, and AI-assisted psychotherapy delivered via chatbots and voice agents. While benefits include reduced wait times and increased patient engagement, we address recurring challenges like algorithmic bias, data privacy, and human-AI collaboration barriers. By introducing a novel four-pillar framework, this review provides a comprehensive roadmap for AI-augmented mental health care, offering actionable insights for researchers, clinicians, and poli

Industry 4.0 in health care has evolved drastically over the past century. In fact, it is evolving every day, with new tools and strategies being developed by physicians and researchers alike. Health care and technology have been intertwined together with the advancement of cloud computing and big data. This study aims to analyze the impact of industry 4.0 in health care systems. To do so, a systematic literature review was carried out considering peer-reviewed articles extracted from the two popular databases: Scopus and Web of Science (WoS). PRISMA statement 2015 was used to include and exclude that data. At first, a bibliometric analysis was carried out using 346 articles considering the following factors: publication by year, journal, authors, countries, institutions, authors' keywords, and citations. Finally, qualitative analysis was carried out based on selected 32 articles considering the following factors: a conceptual framework, schedule problems, security, COVID-19, digital supply chain, and blockchain technology. Study finding suggests that during the onset of COVID-19, health care and industry 4.0 has been merged and evolved jointly, considering various crisis such as d

The Oregon Health Insurance Experiment (OHIE) offers a unique opportunity to examine the causal relationship between Medicaid coverage and happiness among low-income adults, using an experimental design. This study leverages data from comprehensive surveys conducted at 0 and 12 months post-treatment. Previous studies based on OHIE have shown that individuals receiving Medicaid exhibited a significant improvement in mental health compared to those who did not receive coverage. The primary objective is to explore how Medicaid coverage impacts happiness, specifically analyzing in which direction variations in healthcare spending significantly improve mental health: higher spending or lower spending after Medicaid. Utilizing instrumental variable (IV) regression, I conducted six separate regressions across subgroups categorized by expenditure levels and happiness ratings, and the results reveal distinct patterns. Enrolling in OHP has significantly decreased the probability of experiencing unhappiness, regardless of whether individuals had high or low medical spending. Additionally, it decreased the probability of being pretty happy and having high medical expenses, while increasing the

Objectieve:This review aims to deliver a comprehensive analysis of Large Language Models (LLMs) utilization in mental health care, evaluating their effectiveness, identifying challenges, and exploring their potential for future application. Materials and Methods: A systematic search was performed across multiple databases including PubMed, Web of Science, Google Scholar, arXiv, medRxiv, and PsyArXiv in November 2023. The review includes all types of original research, regardless of peer-review status, published or disseminated between October 1, 2019, and December 2, 2023. Studies were included without language restrictions if they employed LLMs developed after T5 and directly investigated research questions within mental health care settings. Results: Out of an initial 313 articles, 34 were selected based on their relevance to LLMs applications in mental health care and the rigor of their reported outcomes. The review identified various LLMs applications in mental health care, including diagnostics, therapy, and enhancing patient engagement. Key challenges highlighted were related to data availability and reliability, the nuanced handling of mental states, and effective evaluation

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

Prognostics is concerned with predicting the future health of the equipment and any potential failures. With the advances in the Internet of Things (IoT), data-driven approaches for prognostics that leverage the power of machine learning models are gaining popularity. One of the most important categories of data-driven approaches relies on a predefined or learned health indicator to characterize the equipment condition up to the present time and make inference on how it is likely to evolve in the future. In these approaches, health indicator forecasting that constructs the health indicator curve over the lifespan using partially observed measurements (i.e., health indicator values within an initial period) plays a key role. Existing health indicator forecasting algorithms, such as the functional Empirical Bayesian approach, the regression-based formulation, a naive scenario matching based on the nearest neighbor, have certain limitations. In this paper, we propose a new `generative + scenario matching' algorithm for health indicator forecasting. The key idea behind the proposed approach is to first non-parametrically fit the underlying health indicator curve with a continuous Gauss

Scarcity of health care resources could result in the unavoidable consequence of rationing. For example, ventilators are often limited in supply, especially during public health emergencies or in resource-constrained health care settings, such as amid the pandemic of COVID-19. Currently, there is no universally accepted standard for health care resource allocation protocols, resulting in different governments prioritizing patients based on various criteria and heuristic-based protocols. In this study, we investigate the use of reinforcement learning for critical care resource allocation policy optimization to fairly and effectively ration resources. We propose a transformer-based deep Q-network to integrate the disease progression of individual patients and the interaction effects among patients during the critical care resource allocation. We aim to improve both fairness of allocation and overall patient outcomes. Our experiments demonstrate that our method significantly reduces excess deaths and achieves a more equitable distribution under different levels of ventilator shortage, when compared to existing severity-based and comorbidity-based methods in use by different government

Abundant evidence has tracked the labour market and health assimilation of immigrants, including static analyses of differences in how foreign-born and native-born residents consume health care services. However, we know much less about how migrants' patterns of health care usage evolve with time of residence, especially in countries providing universal or quasi-universal coverage. We investigate this process in Spain by combining all the available waves of the local health survey, which allows us to separately identify period, cohort, and assimilation effects. We find that the evidence of health assimilation is limited and solely applies to migrant females' visits to general practitioners. Nevertheless, the differential effects of ageing on health care use between foreign-born and native-born populations contributes to the convergence of utilisation patterns in most health services after 20 years in Spain. Substantial heterogeneity over time and by region of origin both suggest that studies modelling future welfare state finances would benefit from a more thorough assessment of migration.

Behavioral risk factors, i.e., smoking, poor nutrition, alcohol misuse, and physical inactivity (SNAP), are leading contributors to chronic diseases and healthcare costs worldwide. Their prevalence is shaped %not only by demographic characteristics %but and also by contextual ones such as socioeconomic and occupational environments. In this study, we leverage data from the Italian health and behavioral surveillance system PASSI to model SNAP behaviors through a Bayesian framework that integrates textual information on occupations. We use Structural Topic Modeling (STM) to cluster free-text job descriptions into latent occupational groups, which inform mixture weights in a multivariate ordered probit model. Covariate effects are allowed to vary across occupational clusters and evolve over time. To enhance interpretability and variable selection, we impose non-local spike-and-slab priors on regression coefficients. Finally, an online learning algorithm based on sequential Monte Carlo enables efficient updating as new data become available. This dynamic, scalable, and interpretable approach permits observing how occupational contexts modulate the impact of socio-demographic factors on

Selecting the right monitoring level in Remote Patient Monitoring (RPM) systems for e-healthcare is crucial for balancing patient outcomes, various resources, and patient's quality of life. A prior work has used one-dimensional health representations, but patient health is inherently multidimensional and typically consists of many measurable physiological factors. In this paper, we introduce a multidimensional health state model within the RPM framework and use dynamic programming to study optimal monitoring strategies. Our analysis reveals that the optimal control is characterized by switching curves (for two-dimensional health states) or switching hyper-surfaces (in general): patients switch to intensive monitoring when health measurements cross a specific multidimensional surface. We further study how the optimal switching curve varies for different medical conditions and model parameters. This finding of the optimal control structure provides actionable insights for clinicians and aids in resource planning. The tunable modeling framework enhances the applicability and effectiveness of RPM services across various medical conditions.

Long-term care service for old people is in great demand in most of the aging societies. The number of nursing homes residents is increasing while the number of care providers is limited. Due to the care worker shortage, care to vulnerable older residents cannot be fully tailored to the unique needs and preference of each individual. This may bring negative impacts on health outcomes and quality of life among institutionalized older people. To improve care quality through personalized care planning and delivery with limited care workforce, we propose a new care planning model assisted by artificial intelligence. We apply bandit algorithms which optimize the clinical decision for care planning by adapting to the sequential feedback from the past decisions. We evaluate the proposed model on empirical data acquired from the Systems for Person-centered Elder Care (SPEC) study, a ICT-enhanced care management program.

Robot-Assisted Therapy (RAT) has successfully been used in Human Robot Interaction (HRI) research by including social robots in health-care interventions by virtue of their ability to engage human users in both social and emotional dimensions. Robots used for these tasks must be designed with several user groups in mind, including both individuals receiving therapy and care professionals responsible for the treatment. These robots must also be able to perceive their context of use, recognize human actions and intentions, and follow the therapeutic goals to perform meaningful and personalized treatment. Effective interactions require for robots to be capable of coordinated, timely behavior in response to social cues. This means being able to estimate and predict levels of engagement, attention, intentionality and emotional state during human-robot interactions. An additional challenge for social robots in therapy and care is the wide range of needs and conditions the different users can have during their interventions, even if they may share the same pathologies their current requirements and the objectives of their therapies can varied extensively. Therefore, it becomes crucial for

Growth of the older adult population has led to an increasing interest in technology-supported aged care. However, the area has some challenges such as a lack of caregivers and limitations in understanding the emotional, social, physical, and mental well-being needs of seniors. Furthermore, there is a gap in the understanding between developers and ageing people of their requirements. Digital health can be important in supporting older adults wellbeing, emotional requirements, and social needs. Requirements Engineering (RE) is a major software engineering field, which can help to identify, elicit and prioritize the requirements of stakeholders and ensure that the systems meet standards for performance, reliability, and usability. We carried out a systematic review of the literature on RE for older adult digital health software. This was necessary to show the representatives of the current stage of understanding the needs of older adults in aged care digital health. Using established guidelines outlined by the Kitchenham method, the PRISMA and the PICO guideline, we developed a protocol, followed by the systematic exploration of eight databases. This resulted in 69 primary studies o

This study is mainly aimed at evaluating the effectiveness of current health care systems of several representative countries and improving that of the US. To achieve these goals, a people-oriented non-linear evaluation model is designed. It comprises one major evaluation metric and four minor metrics. The major metric is constituted by combining possible factors that most significantly determine or affect the life expectancy of people in this country. The four minor metrics evaluate less important aspects of health care systems and are subordinate to the major one. The authors rank some of the health care systems in the world according to the major metric and detect problems in them with the help of minor ones. It is concluded that the health care system of Sweden scores higher than the US and Chinese system scores lower than that of the US. Especially, the health care system of US lags behind a little bit compared with its economic power. At last, it is reasonable for the American government to optimize the arrangement of funding base on the result of goal programming model.

Objective: To enhance health literacy and accessibility of health information for a diverse patient population by developing a patient-centered artificial intelligence (AI) solution using large language models (LLMs) and Fast Healthcare Interoperability Resources (FHIR) application programming interfaces (APIs). Materials and Methods: The research involved developing LLM on FHIR, an open-source mobile application allowing users to interact with their health records using LLMs. The app is built on Stanford's Spezi ecosystem and uses OpenAI's GPT-4. A pilot study was conducted with the SyntheticMass patient dataset and evaluated by medical experts to assess the app's effectiveness in increasing health literacy. The evaluation focused on the accuracy, relevance, and understandability of the LLM's responses to common patient questions. Results: LLM on FHIR demonstrated varying but generally high degrees of accuracy and relevance in providing understandable health information to patients. The app effectively translated medical data into patient-friendly language and was able to adapt its responses to different patient profiles. However, challenges included variability in LLM responses a