Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).

Objective: This study synthesises the effectiveness and applicability of trigger tools for detecting adverse events (AEs) across various healthcare settings. Design: This study used an umbrella review to consolidate findings from existing systematic reviews, assess the quality of evidence and identify gaps in current knowledge. Methods: A comprehensive search was conducted across SCOPUS, Web of Science and PubMed, and included systematic reviews and meta-analyses from 2009 to 2024 focusing on trigger tools used in healthcare settings. Data extraction and quality appraisal followed Joanna Briggs Institute guidelines. Narrative synthesis was employed owing to the heterogeneity among studies. Nine systematic reviews were included. Results: Nine systematic reviews were analysed. Results showed substantial variation in trigger tool performance. Detection rates ranged from 0.8% to 66% across healthcare settings and populations. Preventability rates varied widely from 7% to 94.4%. Automated detection methods demonstrated inconsistent results with AE prevalence, ranging from 0.1% to 29.2%. The studies within the reviews exhibited significant variability in the types of trigger tools analysed and the methodologies used, affecting detection outcomes. The quality of the included studies varied, with inconsistent definitions of AEs and differences in study design limiting the generalisability of the findings. Conclusions: Trigger tools vary significantly in effectiveness, influenced by healthcare context and tool design. Automated methods need refinement. Standardised methodologies and context-specific tools are essential to improve patient safety. Future research should focus on these areas to enhance the accuracy and applicability of trigger tools in different healthcare settings. PROSPERO registration number: CRD42024581456.

BACKGROUND The literature on value-based healthcare (VBHC) implementation has expanded rapidly but remains heterogeneous, making synthesis difficult. This study aimed to map the thematic landscape of VBHC implementation and identify recurring domains, cross-cutting patterns, and gaps in the evidence. OBJECTIVE To map and synthesize the thematic landscape of the value-based healthcare (VBHC) implementation literature using computational thematic synthesis, identifying recurring domains, cross-cutting patterns, and evidence gaps. METHODS PubMed was searched without date restrictions and limited to English-language publications. Screening and full-text eligibility assessment were conducted manually in two stages. Eligible full texts were embedded using a text-embedding model (text-embedding-3-large, 3,072 dimensions), projected with UMAP, and clustered with HDBSCAN using consensus across 10 random seeds. Cluster stability was examined using an alternative embedding model, direct-space clustering, and negative controls. RESULTS A total of 8,957 records were screened, and 351 full-text articles were included. Computational synthesis identified 18 themes that grouped into four broader domains: condition-specific VBHC applications, measurement and costing approaches, organisational and workforce models, and health system policy and governance. Commentaries and framework papers were the most common design category (19.4%), while empirical studies were comparatively fewer across most themes. The United States and the Netherlands contributed the largest share of publications. Themes supported by stronger measurement infrastructure, including PROMs, ICHOM outcome sets, and TDABC, were more frequently associated with reported value improvements. CONCLUSIONS This evidence-mapping study provides a broad overview of the VBHC implementation literature. Despite wide diffusion of the concept, much of the field remains centred on conceptual discussion rather than empirical evaluation. Future work should prioritise interventional designs and context-sensitive implementation frameworks, particularly in under-represented regions.