BMJ Qual Saf 23:534-542 doi:10.1136/bmjqs-2013-002707
  • Original research

Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery

Editor's Choice
  1. Andrew Hutchings
  1. Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Nick Black, Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK;{at}
  • Received 26 November 2013
  • Revised 6 January 2014
  • Accepted 12 January 2014
  • Published Online First 7 February 2014


Objective Our aim was to see if the reporting of better experiences by elective surgical patients was associated with better outcomes (effectiveness and safety). The objectives were to: describe the distribution of experience scores and any association with patients’ characteristics; determine the relationship of experience with effectiveness and with safety; and explore the influence of patient characteristics, year and provider on the relationship between experience and effectiveness.

Methods Patients undergoing one of three procedures from 2010 to 2012 in England who completed a patient reported outcome measure (PROM) questionnaire before and after surgery and a patient reported experience measure (PREM) questionnaire. Data on 4089 hip replacement patients, 4501 knee replacements and 1793 groin hernia repairs. Regression analysis was used to examine associations between disease-specific and generic PROMs and PREMs.

Results There was a weak positive association between experience and effectiveness for all three procedures (correlation coefficient with disease-specific PROMs for hip and knee replacements 0.2 and with EQ-5D 0.1 for all three procedures). The aspect of experience most strongly associated with a better outcome was the level of communication with and trust in their doctor. A higher experience score of 1 SD (about 1.5 on a 10-point scale) was associated with about 30% less likelihood of the patient reporting a complication. There was no difference between the eight dimensions of experience.

All the relationships observed were consistent over time, between different types of patients (age, sex, socioeconomic status) and between providers.

Conclusions Patients distinguish between the three domains of quality when reporting their experience and outcome. If the weak positive associations between domains were shown to be causal, there would be implications for maximising performance measures for providers.