[Using Trigger Tool to detect incidents and adverse events in a mutual insurance company that collaborate with the Social Security system].

Objective: To evaluate differences between the detection of incidents or adverse events (I/AE) using a Trigger Tool (TT) and voluntary notification platform (SNEA).

Methods: The study population is the working population attended on an outpatient basis in an Insurance Company ("mutua") from January to September 2016. The cases declared as Incident or Adverse Event (I / AE) were selected through the SNEA (21 cases), according to whether the event has not affected the patient or on the contrary has affected him. On the other hand, 20 clinical histories per month were randomly selected where the TT was applied(180 cases). The 201 clinical histories were reviewed looking for the existence of triggers. The agreement between the SNEA system and the TT was evaluated using proportion of positive agreement (I/EA), proportion of negative agreement (not I/EA) and Kappa index.

Results: TT detected I/EA cases in 41.3% of the revisions while the SNEA was 10.3% (p<0.001). The Kappa index showed a low concordance value (Kappa = 0.12), which indicates the small coincidence of I/EA detected by both systems. The proportion of negative agreement was greater than that of positive agreement (74.5% versus 26.9%). The SNEA system detected less I/ EA and above all it deals with fewer incidents. On the contrary, the TT system detected a greater number of I EA and especially EA.

Conclusions: Trigger Tool is a recommended tool for the detection of incidents or adverse events that can complement the one obtained through voluntary notification platform in the reality of a "mutua".