PMID- 37707868 OWN - NLM STAT- MEDLINE DCOM- 20231128 LR - 20240425 IS - 1549-8425 (Electronic) IS - 1549-8417 (Print) IS - 1549-8417 (Linking) VI - 19 IP - 8 DP - 2023 Dec 1 TI - Validation of a Reduced Set of High-Performance Triggers for Identifying Patient Safety Incidents with Harm in Primary Care: TriggerPrim Project. PG - 508-516 LID - 10.1097/PTS.0000000000001161 [doi] AB - OBJECTIVE: The aim of the study was to construct and validate a reduced set of high-performance triggers for identifying adverse events (AEs) via electronic medical records (EMRs) review in primary care (PC). METHODS: This was a cross-sectional descriptive study for validating a diagnostic test. The study included all 262 PC centers of Madrid region (Spain). Patients were older than 18 years who attended their PC center over the last quarter of 2018. The randomized sample was n = 1797. Main measurements were as follows: ( a ) presence of each of 19 specific computer-identified triggers in the EMR and ( b ) occurrence of an AE. To collect data, EMR review was conducted by 3 doctor-nurse teams. Triggers with statistically significant odds ratios for identifying AEs were selected for the final set after adjusting for age and sex using logistic regression. RESULTS: The sensitivity (SS) and specificity (SP) for the selected triggers were: >/=3 appointments in a week at the PC center (SS = 32.3% [95% confidence interval CI, 22.8%-41.8%]; SP = 92.8% [95% CI, 91.6%-94.0%]); hospital admission (SS = 19.4% [95% CI, 11.4%-27.4%]; SP = 97.2% [95% CI, 96.4%-98.0%]); hospital emergency department visit (SS = 31.2% [95% CI, 21.8%-40.6%]; SP = 90.8% [95% CI, 89.4%-92.2%]); major opioids prescription (SS = 2.2% [95% CI, 0.0%-5.2%]; SP = 99.8% [95% CI, 99.6%-100%]); and chronic benzodiazepine treatment in patients 75 years or older (SS = 14.0% [95% CI, 6.9%-21.1%]; SP = 95.5% [95% CI, 94.5%-96.5%]).The following values were obtained in the validation of this trigger set (the occurrence of at least one of these triggers in the EMR): SS = 60.2% (95% CI, 50.2%-70.1%), SP = 80.8% (95% CI, 78.8%-82.6%), positive predictive value = 14.6% (95% CI, 11.0%-18.1%), negative predictive value = 97.4% (95% CI, 96.5%-98.2%), positive likelihood ratio = 3.13 (95% CI, 2.3-4.2), and negative likelihood ratio = 0.49 (95% CI, 0.3-0.7). CONCLUSIONS: The set containing the 5 selected triggers almost triples the efficiency of EMR review in detecting AEs. This suggests that this set is easily implementable and of great utility in risk-management practice. CI - Copyright (c) 2023 The Author(s). Published by Wolters Kluwer Health, Inc. FAU - Garzon Gonzalez, Gerardo AU - Garzon Gonzalez G AD - From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Alonso Safont, Tamara AU - Alonso Safont T AD - Information Systems Unit, Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Conejos Miquel, Dolores AU - Conejos Miquel D AD - From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Castelo Jurado, Marta AU - Castelo Jurado M AD - "Federica Montseny" Primary Healthcare Centre (Centro de Salud Federica Montseny), Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Aguado Arroyo, Oscar AU - Aguado Arroyo O AD - "Francia" Primary Healthcare Centre (Centro de Salud Francia), Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Jurado Balbuena, Juan Jose AU - Jurado Balbuena JJ AD - "Alicante" Primary Healthcare Centre (Centro de Salud Alicante), Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Villanueva Sanz, Cristina AU - Villanueva Sanz C AD - "Vicente Muzas" Primary Healthcare Centre (Centro de Salud Vicente Muzas), Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Zamarron Fraile, Ester AU - Zamarron Fraile E AD - "Baviera" Primary Healthcare Centre (Centro de Salud Baviera), Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Luaces Gayan, Arancha AU - Luaces Gayan A AD - "Torrelodones" Primary Healthcare Centre (Centro de Salud Torrelodones), Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Canada Dorado, Asuncion AU - Canada Dorado A AD - From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Martinez Patino, Dolores AU - Martinez Patino D AD - From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Magan Tapia, Purificacion AU - Magan Tapia P AD - From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Barbera Martin, Aurora AU - Barbera Martin A AD - From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). FAU - Toribio Vicente, Maria Jose AU - Toribio Vicente MJ AD - "Gregorio Maranon" University General Hospital (Hospital General Universitario Gregorio Maranon), Madrid Health Service (SERMAS). FAU - Drake Canela, Mercedes AU - Drake Canela M AD - "Infanta Leonor" University Hospital (Hospital Universitario Infanta Leonor), Madrid Health Service (SERMAS), Madrid (Spain). FAU - Mediavilla Herrera, Inmaculada AU - Mediavilla Herrera I AD - From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atencion Primaria), Madrid Health Service (SERMAS). LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230914 PL - United States TA - J Patient Saf JT - Journal of patient safety JID - 101233393 SB - IM MH - Humans MH - Cross-Sectional Studies MH - Electronic Health Records MH - *Medical Errors/prevention & control MH - *Patient Safety MH - Primary Health Care MH - Adult PMC - PMC10662617 COIS- The authors disclose no conflict of interest. EDAT- 2023/09/14 12:42 MHDA- 2023/11/20 06:54 PMCR- 2023/11/21 CRDT- 2023/09/14 11:43 PHST- 2023/11/20 06:54 [medline] PHST- 2023/09/14 12:42 [pubmed] PHST- 2023/09/14 11:43 [entrez] PHST- 2023/11/21 00:00 [pmc-release] AID - 01209203-990000000-00149 [pii] AID - JPS_230357 [pii] AID - 10.1097/PTS.0000000000001161 [doi] PST - ppublish SO - J Patient Saf. 2023 Dec 1;19(8):508-516. doi: 10.1097/PTS.0000000000001161. Epub 2023 Sep 14.