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Due to increasing complexity, modern radiotherapy techniques require comprehensive quality assurance (QA) programmes, that to date generally focus on the pre-treatment stage. The purpose of this paper is to provide a method for an individual patient treatment QA evaluation and identification of a “quality gap” for continuous quality improvement.

A statistical process control (SPC) was applied to evaluate treatment delivery using in vivo electronic portal imaging device (EPID) dosimetry. A moving range control chart was constructed to monitor the individual patient treatment performance based on a control limit generated from initial data of 90 intensity-modulated radiotherapy (IMRT) and ten volumetric-modulated arc therapy (VMAT) patient deliveries. A process capability index was used to evaluate the continuing treatment quality based on three quality classes: treatment type-specific, treatment linac-specific, and body site-specific.

The determined control limits were 62.5 and 70.0 per cent of the χ pass-rate for IMRT and VMAT deliveries, respectively. In total, 14 patients were selected for a pilot study the results of which showed that about 1 per cent of all treatments contained errors relating to unexpected anatomical changes between treatment fractions. Both rectum and pelvis cancer treatments demonstrated process capability indices were less than 1, indicating the potential for quality improvement and hence may benefit from further assessment.

The study relied on the application of in vivo EPID dosimetry for patients treated at the specific centre. Sampling patients for generating the control limits were limited to 100 patients. Whilst the quantitative results are specific to the clinical techniques and equipment used, the described method is generally applicable to IMRT and VMAT treatment QA. Whilst more work is required to determine the level of clinical significance, the authors have demonstrated the capability of the method for both treatment specific QA and continuing quality improvement.

The proposed method is a valuable tool for assessing the accuracy of treatment delivery whilst also improving treatment quality and patient safety.

Assessing in vivo EPID dosimetry with SPC can be used to improve the quality of radiation treatment for cancer patients.

Modern e‐health systems incorporate different healthcare providers in one system and provide an electronic platform to share medical information efficiently. In cross‐context communications between healthcare providers, the same information can be interpreted as different types or values, so that one patient will be issued different identifiers by different healthcare providers. This paper aims to provide a solution to ensure interoperability so that multiple healthcare providers will be able to collaborate in one e‐health system.

This paper primarily focuses on how different healthcare providers, instead of the patients, are able to interact and share information on a common e‐health platform.

In the course of the work, it was found that previous e‐health solutions mainly have a limited view of patient information, where a user‐centric approach for identity management is usually restricted to a single healthcare provider. Interoperability in an e‐health system becomes more problematic when more actors collaborate, and hence linkability from one context to another should not be straightforward. However, some form of linkability, such as the possibility to follow up a patient's medical treatment, is desirable in the e‐health sector, even when it needs to cross different contexts. Therefore, the authors have designed an identity management mechanism to ensure semantic interoperability when data is exchanged among different authorized healthcare providers.

The paper points out that the next generation of e‐health will move towards federated e‐health and will require user‐centricity and transparency properties so that patients are able to specify and verify the disclosure of their medical information.

This paper proposes a new service for cross‐context identity management in e‐health systems, improving interoperability between agencies when context‐specific information is transferred from one healthcare provider to another. How the proposed cross‐context identity management service can be integrated in an e‐health system is explained with a use case scenario.

The purpose of this study was to determine which Department of Defense (DOD) active duty patient sociodemogpraphic, health status, geographic location, and utilization factors, predict overall patient satisfaction with health care in military facilities. A theoretical framework developed from patient satisfaction and social identity theories and from previous empirical findings was used to develop a model to predict patient satisfaction and delineate moderating variables. The major finding indicated in this study was the significance of patients’ characteristics in moderating their satisfaction. Principal components factor analysis and hierarchical linear regression revealed that patient specific factors predicted patients’ satisfaction after controlling for factors depicting patients’ evaluations of health system characteristics. Patient specific factors provided added, although very minimal, explanatory value to the determination of patients’ satisfaction. The study findings can aid in the development of targeted, objectively prioritized programs of improvement and marketing by ranking variables using patients’ passively derived importance schema.

To review the experience of managing two patients with identical names in the same ward during a five‐month period.

The records of the patients were reviewed to look for incorrect entries, errors in specimens sampling, administration of blood products and chemotherapy, and misplacement of clinical notes. Doctors and nurses involved were also invited to complete a questionnaire study to comment on the usefulness of the measures implemented for correct patient identification. A random sample of 60 patients was also selected to see if their full names were shared with other patients attending the same hospital.

Among the 1,442 sheets of hospital records from the two patients, no errors pertaining to the clinical activities were found. However, 13 (0.9 per cent) sheets of the hospital records were misplaced. The 21 doctors and nurses participating in the questionnaire study gave positive support to all the additional measures implemented for safeguarding patient identification, of which the automated alerting feature in the electronic clinical management system received the highest scores. A total of 32 (53 per cent) of the 60 sampled patients shared a common full name with one to 101 other patients attending the same hospital.

Patients with identical names staying in the same ward present a unique challenge to acute health‐care settings. The situation is especially relevant in communities where most people's names are not unique. Specific guidelines and measures are needed to prevent patient misidentification. Errors in filing of patient notes and laboratory reports to the hospital record deserve further attention.

The purpose of this paper is to examine an operational process through the use of a clinical practice improvement method to implement clinical pathways in the Amber Hospital's (name changed for privacy reasons) cardiology unit. This quality framework has been adopted as a means of preventing adverse events, to ensure quality of care is provided to all patients.

A quality assurance case study approach was adopted along with the clinical practice improvement method – a framework that allows continuous quality improvement to be applied in a practical way to clinical processes, in order to improve delivery of care. The clinical practice improvement method is broken into five cycles: project, diagnostic phase, intervention, impact, and sustaining improvement. The paper explains these cycles, demonstrating how each was achieved.

The clinical practice improvement method at Amber Hospital was found to provide superior performance in the clinical pathway allocation process and improved patient care. Having an appropriate and effective action plan involving clinical pathways helps to prevent service hindrances that may have adverse impact on hospital management processes leading to adverse events. The Amber Hospital case study has not only identified the physical constraints but also the constraints in relation to organization policies and operation procedures.

The paper highlights the need for organizations to have a “no blame” culture, which acknowledged that errors do and will occur. However, it is also recognized that it is important to have reliable data collection on these errors, in order to reduce the frequency and severity of adverse events. Lack of available data was a severe limitation.

The practical aim of this project was to improve recommended drug treatment in patients with Acute Coronary Syndrome through the implementation of clinical pathways. The author also wanted to measure the utilization rate of these pathways. While there were four pathways implemented, the majority of patients were allocated to pathway 1B. Hence, data were collected on those specific patients.

Quality operational framework, using a clinical practice improvement method, demonstrated how clinical pathways for Acute Coronary Syndrome were implemented successfully at the Amber Hospital. The report provides evidence that through conducting a CPI project, quality improvements were made in recommended drug treatment for patients diagnosed with Acute Coronary Syndrome, and to correct pathway allocation.

This study aims to assess whether patients [who receive community pharmacy services at locations where routine medication therapy management (MTM) care is reimbursed] who were adherent to their medications generated lower inpatient hospitalization expenses.

This is a retrospective, descriptive and cross-sectional study using administrative claims data drawn from 84 community pharmacies in North Dakota. The included patients were enrolled in a Blue Cross Blue Shield of North Dakota insurance plan and were taking one or more of eight groups of medications (metformin, antidepressants, anti-asthmatics, ACEs/ARBs, beta-blockers, calcium channel blockers, diuretics and statins) commonly prescribed to treat chronic conditions filled between July 1, 2014 and June 30, 2015. Community pharmacists used software that allowed the pharmacists to provide and bill for MTM services. Data from these sources were used to calculate medication adherence and inpatient costs.

Patients prescribed a beta blocker, a calcium channel blocker, and a diuretic or an anti-diabetic medication, and those who are fully adherent to their medications were associated with significantly lower inpatient hospitalization costs (as measured by insurance payments to hospitals) as compared to non-adherent patients. Patients who were fully adherent to their medications had no statistically significant differences in patient-specific costs compared to non-adherent patients.

Patients receiving services at a community pharmacy that offers MTM services and those who were adherent to their medication regimens generate lower health care expenses. Most of the savings come from lower hospitalization expenses, rather than patient-paid expenses.

Patient safety is gaining prominence in health professional curricula. Patient safety must be complemented by teaching and skill development in practice settings. The purpose of this paper is to explore how experienced pharmacists identify, prioritize and communicate adverse drug effects to patients.

A focus group discussion was conducted with cardiology pharmacy specialists working in a Doha hospital, Qatar. The topic guide sought to explore participants’ views, experiences and approaches to educating patients regarding specific cardiovascular therapy safety and tolerability. Discussions were audio-recorded and transcribed verbatim. Data were coded and organized around identified themes and sub-themes. Working theories were developed by the three authors based on relevant topic characteristics associated with the means in which pharmacists prioritize and choose adverse effect information to communicate to patients.

Nine pharmacists participated in the discussion. The specific adverse effects prioritized were consistent with the reported highest prevalence. Concepts and connections to three main themes described how pharmacists further tailored patient counseling: potential adverse effects and their perceived importance; patient encounter; and cultural factors. Pharmacists relied on initial patient dialogue to judge an individual’s needs and capabilities to digest safety information, and drew heavily upon experience with other counseling encounters to further prioritize this information, processes dependent upon development and accessing exemplar cases.

The findings underscore practical experience as a critical instructional element of undergraduate health professional patient safety curricula and for developing associated clinical reasoning.

This chapter proposes an optimized innovative information technology as a means for achieving operational functionalities of real-time portable electronic health records, system interoperability, longitudinal health-risks research cohort and surveillance of adverse events infrastructure, and clinical, genome regions – disease and interventional prevention infrastructure. In application to the Dod-VA (Department of Defense and Veteran's Administration) health information systems, the proposed modernization can be carried out as an “add-on” expansion (estimated at $288 million in constant dollars) or as a “stand-alone” innovative information technology system (estimated at $489.7 million), and either solution will prototype an infrastructure for nation-wide health information systems interoperability, portable real-time electronic health records (EHRs), adverse events surveillance, and interventional prevention based on targeted single nucleotide polymorphisms (SNPs) discovery.

Interprofessional education (IPE) has been highly promoted as a means of enhancing interprofessional practice and thereby having a positive impact on healthcare systems and patient outcomes. Various documents mention that sufficient evidence has been accumulated to demonstrate the effectiveness of IPE, yet it is not completely clear what type of evidence is being alluded to. The objective of this review was to gather evidence about IPE programs that resulted in effective long-term outcomes in healthcare. Secondary outcomes included identification of the types of models that met the success criteria, barriers and facilitators of such successful programs if any.

A systematic search was conducted in PubMed, Web of Science, CINAHL and Scopus. The review considered studies that targeted undergraduate and postgraduate students among more than one health profession and included those in the English language published between 2010 and end of 2020.

Five studies have been identified and described in this review. These papers evaluated different IPE programs and models.

1. This systematic review investigated the evidence of the existence of IPE programs and the findings show there is no robust specific evidence of long-term impact on healthcare and on patients' outcomes. 2. The conclusion from this review is that it is still unclear what format constitutes a successful and efficient program. 3. Appropriate longitudinal studies need to be designed to identify the impact of IPE on long-term health outcomes.

Overall, the studies show that although there is an emphasis on practice-based learning, there is no robust specific evidence of long-term impact on healthcare and on patients' outcomes. Appropriate longitudinal studies need to be designed to identify the impact of IPE on long-term health outcomes.

The purpose of this paper is to provide the results of a case study that examined the application of platform design to improve the integration of patient care services across the continuum of care. This paper is designed to spark discussion and encourage further research in this area.

The research in the paper involved a case study of a large health care provider in a major metropolitan area. The authors of this paper worked with directors of case management departments and other managerial personnel within the enterprise to study the case management interface services between different inpatient and outpatient facilities to examine existing processes, identify deficiencies, and to recommend improvements in case management.

The paper finds that the current case management system of the provider, as structured, was not fulfilling its potential for achieving medical quality, operational cost, or patient satisfaction. A number of areas where improvements could be made were identified, and an integrated case management approach based on modular platform design was recommended as a key approach to realize such improvements.

The paper shows that this study involves only one major provider and therefore the direct application of an integrated case management approach based on platform design to other providers would have to be further researched. However, the proposed integrated, cross‐continuum model of case management appears to be a novel way to both improve care and achieve financial cost efficiencies.

The case study in this paper demonstrates how innovative thinking and the use of techniques typically associated with “Platform architectures” can have direct application in the health care sector.

The paper shows that as health care providers are continuously working to improve the quality of care within specific areas of clinical care, improvement in the interfaces between these specific areas may also improve the quality and cost of care. This case study applies modular services design to show how the planning and delivering patient services across the entire “Continuum of care”, which includes the transfer of patients, care coordination, and medical information management can achieve that desired result.