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Contents Meeting Summary Contents

 Review of the Trigger Literature

 Considering Sensitivity & Positive Predictive Value

 Triggers & TIDS: Aiming for the Right Target

 Reflections on the IHI Global Trigger Tool

 Diagnostic Event Triggers

 Challenges in Implementation

 Challenges & Incremental Benefits in Implementing TIDS

 Trigger Tool Implementation Experiences in Kaiser Permanente

 Glossary

 List of Participants

Figure 1. A proposed conceptual model to apply triggers to detect diagnostic events in ambulatory care

Our conceptual model in Figure 1 illustrates how Type A and Type B triggers are used to detect diagnostic events in ambulatory care. When an incorrect diagnosis is made in the initial provider-patient encounter, the patient may subsequently return to seek care or be hospitalized. Type A triggers are used to detect such situations. Diagnosis may also be uncertain at times, in which case diagnostic tests or consultations are requested. These latter processes could lead to diagnostic events related to loss of follow-up of abnormal test results or of patients. Type B triggers can be applied to detect these events.

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