THE CHALLENGE
More than half of surgeries resulting in mortality and lifelong complications occur within the first 30 days of discharge. These potentially avoidable occurrences result from unplanned readmissions costing health systems approximately 15 to 20 billion dollars each year1. Apart from financials these events impact quality of care, referrals, bed availability, brand, and challenges in maintaining payer status, reimbursement levels and timelines. 
THE RESEARCH
Patients' and caregivers' lack of information of how to manage pain, wounds, anxiety, food, sleep, mobility, and constipation post-discharge contributes to 30-day re-admission. Complications within the first 30 days after discharge are also exacerbated by delayed decision-making for emergency room visits and prescription non-adherence. Effective discharge planning requires a thorough understanding of the patient's clinical and social support systems2. Numerous factors contribute to the poor discharge process, including gaps in hospital policy and a lack of health literacy on the part of patients or caregivers.
THE SOLUTION
A progressive self-learning solution driven by a human-centered artificial intelligence and delivered to patients and caregivers via a mobile app that empathically aids patients during the first 30 days following discharge. This personalized mobile assistant communicates with patients and caregivers in a conversational manner, adhering to cultural and linguistic standards of empathy. Additionally, it can translate data into clinical language and inform clinicians and care teams on a consistent basis. Not only can such an app help the patient by providing individualized information in the form of voice, text, videos, and audios, but it may also assist in discovering unmet patient needs, resulting in personalized outcomes

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