Patient-Surrogate Alignment in Digital Advance Care Planning

AI-based advanced care planning platform to align surrogate decision makers to improve end-of-life care
Awardee Organization(s): Koda Health
Principal Investigator(s): Desh Mohan, MD
Official Project Title: Patient-Surrogate Alignment in Digital Advance Care Planning
AITC Partner: PennAITech
Website(s): www.kodahealthcare.com

Advance Care Planning (ACP) encompasses educating patients on potential future healthcare decisions, clarifying patients’ values and healthcare preferences, and sharing decisions with family and care providers. Most individuals lacking decision-making capacity near end-of-life will need a surrogate decision maker (SDM) to make or voice decisions for them. However, less than 25% of SDMs are engaged in the ACP process or aware of patient preferences, and often feel unprepared for decision-making. Koda is a machine learning based ACP platform which offers dynamic educational content, decision guidance, and advanced directive documentation for patients and SDMs. Aims of this study are to: 1) determine motivators of patient-SDM alignment among Koda users and 2) develop a machine learning algorithm to perform SDM persona identification.
Participants will be 50 patient-SDM dyads. Eligible patients will be 50+ years of age, without dementia or blindness. SDMs will be 18+ years old. All participants should have an email address and ability to read and speak English. Following informed consent, patients will complete the Koda ACP platform and a survey about SDMs’ values and experiences. SDMs will complete a self-survey and perceived alignment surveys before and after reviewing the patient’s completed ACP. Survey data will be used to train theSDM persona detection algorithm. Dyads will also be invited to complete qualitative interviews, for further exploration of patient-SDM experiences.This pilot project aims to better understand patientSDM alignments and to develop an algorithm for identification of SDM personas, with the ultimate goal of facilitating increasingly high-quality ACP and goal-concordant care.

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PennAITech Home

The overarching goal of the Penn Artificial Intelligence and Technology (PennAITech) Collaboratory for Healthy Aging is to identify, develop, evaluate, commercialize, and disseminate innovative technology and artificial intelligence (AI) methods and software to support older adults and those with Alzheimer’s Disease (AD) and Alzheimer’s Disease and Related Dementias (ADRD) in their home environment. The Collaboratory is motivated by the need for a comprehensive pipeline from technology-based monitoring of older adults in the home, collection and processing monitoring data, integration of those data with clinical data from electronic health records, analysis with cutting-edge AI methods and software, and deployment of validated AI models at point of care for decision support.

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PennAITech News and Events

You can download our latest newsletter here. We are launching our webinar series for this academic year. The purpose of this webinar is to foster a dialogue exploring clinical, ethical and technological opportunities and challenges associated with the use of technology to promote aging, and to introduce different perspectives at the intersection of informatics and gerontology.

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PennAITech Resources

The overarching goal of the Technology Identification and Training Core is to use evidence from the literature, stakeholder and expert inputs to identify the technology needs of older Americans, as well as develop training activities for artificial intelligence (AI) and technology for scientists, engineers, clinicians, medical professionals, patients, policy makers, and investors.

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PennAITech Youtube Channel

The overarching goal of the Penn Artificial Intelligence and Technology (PennAITech) Collaboratory for Healthy Aging is to identify, develop, evaluate, commercialize, and disseminate innovative technology and artificial intelligence (AI) methods and software to support older adults and those with Alzheimer’s Disease (AD) and Alzheimer’s Disease and Related Dementias (ADRD) in their home environment. The Collaboratory is motivated by the need for a comprehensive pipeline from technology-based monitoring of older adults in the home, collection and processing monitoring data, integration of those data with clinical data from electronic health records, analysis with cutting-edge AI methods and software, and deployment of validated AI models at point of care for decision support. We share PennAITech videos (e.g., webinars, call for applications) in this youtube channel.

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Physiological Detection and Monitoring of Alzheimer’s Disease

Using wireless dry-sensor EEG wearables and an AI-based neural algorithms to detect early-stage AD/ADRD
Awardee Organization(s): Cogwear LLC
Principal Investigator(s): David Yonce, MS, MBA
Official Project Title: Physiological Detection and Monitoring of Alzheimer’s Disease
AITC Partner: PennAITech
Website(s): www.cogweartech.com

Cogwear has developed a wireless dry-sensor EEG wearable that can easily collect clinical-grade brainwave data anywhere, anytime with comfort and no limits on mobility. Initially applied to behavioral health, here we propose to extend our platform to early detection and trending of dementia and Alzheimer’s Disease (AD) based upon brain physiology. With the ability to sense EEG from the frontal and temporal lobes, the parts of the brain that regulate short and long-term memory, planning, and executive functions, our system can detect EEG changes implicated in dementia and AD: slowing, reduced complexity, decrease in synchronization, and neuromodulatory deficits.
Our project will focus on two components: migrating our wearable to a soft goods form factor with downsized electronics more appropriate for in-clinic and home use and begin to develop the EEG signal processing and applications to quantitatively detect and trend brain processes associated with dementia and AD. Deliverables will include an advanced prototype and pilot testing of algorithms with humans in a small sample of healthy and AD/ADRD patients.
Our expectation is that these algorithms will ultimately show efficacy to detect presymptomatic brain changes, allowing intervention by caregivers to prepare patients and families. Further, because subtle EEG shifts can be indicative of changing disease states, we can provide quantitative trending of AD based upon brain physiology, providing new methods to titrate pharmaceuticals and evaluate disease treatments. Through earlier detection and enhanced monitoring, our goal is to better support patients and their families by enabling more years of high-functioning and independent living.

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Radio frequency-based off-body real-time remote monitoring of medication adherence for older adults

Awardee Organization(s): etectRx
Principal Investigator(s): Tony C. Carnes, PhD
Official Project Title: Real-Time Remote Monitoring of Confirmed Medication Adherence
AITC Partner: PennAITech
Website(s): https://etectrx.com

Medication non-adherence is responsible for up to $300 billion of avoidable healthcare costs in the United States with patients over 60 years of age consuming 50% of dispensed prescription drugs. This project enables real-time, remote monitoring of medication ingestions and enhances patient and caregiver feedback to help patients stay adherent and thus extend the time they are able to age grace fully at home.
The existing FDA-cleared IDCap system detects ingested medication signals using a watch or lanyard-style reader worn by the patient and forwards information to a server through an app on a patient’s smart phone. In this proposal we are looking to remove the individuals’ worn reader from the system and replace it with a series of readers placed in multiple locations in a person’s home to ensure ingestion detection without the user changing their usual behavior. Additionally, the new readers will interface with Alexa to facilitate audible and visual reminders and confirmations of medication ingestion. If the end user allows, remote care providers will be able to participate in the adherence journey and intervene when needed.

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RGBd+ Thermal Computer Vision Platform for Home Monitoring and Telehealth

Combining AI-enabled RGBd+ stereo vision and thermal sensors for home monitoring and telehealth
Awardee Organization(s): Bestie Bot
Principal Investigator(s): Richard Everts
Official Project Title: RGBd+ Thermal Computer Vision Platform for Home Monitoring and Telehealth
AITC Partner: PennAITech
Website(s): www.bestiebot.com

We’re developing a new class of a home-based, AI-enabled monitoring system that uses standard computer vision and thermal sensors to detect falls, notify caretakers in case of falland perform basic health diagnostics, all with industry-exceeding privacy and accuracy.
Specifically, we will:
1. Detect falls more reliably in day and night conditions
2. Increase the capabilities of remote health checks through mobility and thermal testing
3. Reduce AI biases for the BIPOC population through our data generation tools and methods
Using unique sensor fusion along with a patented new AI system, our goal is to vastly increase the reliability, adoption, and privacy of in-home monitoring systems for use by those aging in place and their families.

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Smartphone app using heuristic AI to help caregivers prioritize and manage neuropsychiatric symptoms of AD/ADRD

Awardee Organization(s): New York University Rory Meyers College of Nursing
Principal Investigator(s): Ab Brody, PhD, RN, FAAN
Official Project Title: Aliviado Dementia Care Machine Learning Algorithm Development for Caregiving
AITC Partner: PennAITech
Website(s):
https://www.aliviado.org
http://nursing.nyu.edu
https://www.hign.org

Care partners (CP) of persons living with dementia (PLWD) provide crucial support and find significant meaning in the care they provide. They show compassion to those they are caring for, and resilience in the face of adversity. Yet, many CP lack high-quality, evidence-based guidance for addressing care needs of PLWD. One key area that is often challenging to CP, yet where they have little support, is in addressing neuropsychiatric symptoms (NPS) such as agitation or wandering. Most PLWD experience more than one NPS at a time and thus not only do CP lack support in managing these symptoms, they don’t know which symptom to focus on first to reduce their burden and improve the quality of life of the PLWD. This is particularly true in underserved and marginalized communities who are less likely to have access to comprehensive dementia care or supportive services. Higher NPS, particularly in marginalized CP, greatly increases the risk of CP burden, physical and mental health challenges. To help CP make decisions about what NPS to prioritize, we will use artificial intelligence/machine learning (AI/ML) to develop a precision clinical decision support algorithm to assist CP in prioritizing which NPS to treat. The algorithm will be inserted into a user-friendly smartphone application which CP can download through the iOS or Android app store. The app will increase access to high-quality dementia support, empower CP to better manage NPS and improve the quality of life for both themselves and the PLWD.

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Speech processing-based novel algorithm for proactive, automated screening of African American home healthcare patients at risk for MCI and early dementia

Awardee Organization(s): VNS Health | Columbia University Irving Medical Center
Principal Investigator(s): Maryam Zolnoori, PhD
Official Project Title: A Speech-Processing Algorithm for Automatic Screening of African American Patients with Mild Cognitive Impairment and Early Dementia in Home Health Settings
AITC Partner: PennAITech
Website(s):
https://www.cuimc.columbia.edu
http://vnshealth.org

Mild cognitive impairment (MCI) and early-stage dementia (ED) are prevalent concerns, impacting one-in-five adults over age 60. Alarmingly, a significant percentage of these cases remain undiagnosed, leading to missed timely interventions. Our data emphasizes that African American seniors are particularly vulnerable, with existing disparities in healthcare access, biases, and varying health literacy levels exacerbating the situation. A novel observation we intend to leverage is the correlation between linguistic shifts and the onset of cognitive issues. Language, a foundational element of cognition, exhibits early perturbations during cognitive decline. The nuances of these changes can vary across racial boundaries, influenced by dialectic variations such as African American Vernacular English. In this pivotal study, our objective is to architect a diagnostic tool to detect nascent signs of MCI-ED by analyzing African American patients’ verbal communications during regular health consultations. By meticulously recording, processing, and extracting linguistic and phonetic features from these conversations, complemented by additional clinical data, we aim to devise a potent screening algorithm. This initiative aligns seamlessly with the National Institute on Aging’s focus on early identification of cognitive impairment in the elderly. The prospective outcome, an innovative algorithm, holds promise to enhance timely MCI-ED diagnosis efficacy, especially among African American individuals, thereby optimizing care quality and addressing longstanding disparities.

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