New care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistance

Abstract Transitional care may play a vital role in the sustainability of Europe’s future healthcare system, offering solutions for relocating patient care from hospital to home, therefore addressing the growing demand for medical care as the population is ageing. Re-hospitalization for the same ini...

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Main Authors: Ionut Anghel, Tudor Cioara, Roberta Bevilacqua, Federico Barbarossa, Terje Grimstad, Riitta Hellman, Arnor Solberg, Lars Thomas Boye, Ovidiu Anchidin, Ancuta Nemes, Camilla Gabrielsen
Format: Article
Language:English
Published: Nature Portfolio 2025-05-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-03332-w
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author Ionut Anghel
Tudor Cioara
Roberta Bevilacqua
Federico Barbarossa
Terje Grimstad
Riitta Hellman
Arnor Solberg
Lars Thomas Boye
Ovidiu Anchidin
Ancuta Nemes
Camilla Gabrielsen
author_facet Ionut Anghel
Tudor Cioara
Roberta Bevilacqua
Federico Barbarossa
Terje Grimstad
Riitta Hellman
Arnor Solberg
Lars Thomas Boye
Ovidiu Anchidin
Ancuta Nemes
Camilla Gabrielsen
author_sort Ionut Anghel
collection DOAJ
description Abstract Transitional care may play a vital role in the sustainability of Europe’s future healthcare system, offering solutions for relocating patient care from hospital to home, therefore addressing the growing demand for medical care as the population is ageing. Re-hospitalization for the same initial pathological cause is a recurrent problem among older adults with chronic conditions such as heart failure or chronic obstructive pulmonary disease. However, to be effective, it is nowadays essential to integrate into the transitional care process innovative Information and Communications Technology technologies to ensure that patients with comorbidities experience a smooth and coordinated transition from hospitals or care centers to home, thereby reducing the risk of rehospitalization. In this paper, we present an overview of the integration of Internet of Things, artificial intelligence, and digital assistance technologies with traditional care pathways to address the challenges and needs of healthcare systems in Europe. We identify the current gaps in transitional care and define the technology mapping to enhance the care pathways, aiming to improve patient outcomes, safety, and quality of life, avoiding hospital readmissions. Finally, we define the trial setup and evaluation methodology needed to provide clinical evidence that supports the positive impact of technology integration on patient care and discuss the potential effects on the healthcare system.
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spelling doaj-art-526fd7d60a3945dc939226a9bae54c562025-08-20T02:03:35ZengNature PortfolioScientific Reports2045-23222025-05-0115111210.1038/s41598-025-03332-wNew care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistanceIonut Anghel0Tudor Cioara1Roberta Bevilacqua2Federico Barbarossa3Terje Grimstad4Riitta Hellman5Arnor Solberg6Lars Thomas Boye7Ovidiu Anchidin8Ancuta Nemes9Camilla Gabrielsen10Computer Science Department, Technical University of Cluj-NapocaComputer Science Department, Technical University of Cluj-NapocaScientific Direction, IRCCS INRCAScientific Direction, IRCCS INRCAKarde ASKarde ASTellu ASTellu ASNiculae Stancioiu Heart InstituteNiculae Stancioiu Heart InstituteFarsund KommuneAbstract Transitional care may play a vital role in the sustainability of Europe’s future healthcare system, offering solutions for relocating patient care from hospital to home, therefore addressing the growing demand for medical care as the population is ageing. Re-hospitalization for the same initial pathological cause is a recurrent problem among older adults with chronic conditions such as heart failure or chronic obstructive pulmonary disease. However, to be effective, it is nowadays essential to integrate into the transitional care process innovative Information and Communications Technology technologies to ensure that patients with comorbidities experience a smooth and coordinated transition from hospitals or care centers to home, thereby reducing the risk of rehospitalization. In this paper, we present an overview of the integration of Internet of Things, artificial intelligence, and digital assistance technologies with traditional care pathways to address the challenges and needs of healthcare systems in Europe. We identify the current gaps in transitional care and define the technology mapping to enhance the care pathways, aiming to improve patient outcomes, safety, and quality of life, avoiding hospital readmissions. Finally, we define the trial setup and evaluation methodology needed to provide clinical evidence that supports the positive impact of technology integration on patient care and discuss the potential effects on the healthcare system.https://doi.org/10.1038/s41598-025-03332-wTransitional careArtificial intelligenceDigital supportPersonalized careRemote monitoring
spellingShingle Ionut Anghel
Tudor Cioara
Roberta Bevilacqua
Federico Barbarossa
Terje Grimstad
Riitta Hellman
Arnor Solberg
Lars Thomas Boye
Ovidiu Anchidin
Ancuta Nemes
Camilla Gabrielsen
New care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistance
Scientific Reports
Transitional care
Artificial intelligence
Digital support
Personalized care
Remote monitoring
title New care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistance
title_full New care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistance
title_fullStr New care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistance
title_full_unstemmed New care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistance
title_short New care pathways for supporting transitional care from hospitals to home using AI and personalized digital assistance
title_sort new care pathways for supporting transitional care from hospitals to home using ai and personalized digital assistance
topic Transitional care
Artificial intelligence
Digital support
Personalized care
Remote monitoring
url https://doi.org/10.1038/s41598-025-03332-w
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