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What are PREMs? The Definitive Guide to Patient Reported Experience Measures

Everything you need to know about PREMs: definition, what they measure, and how they transform the patient experience.

Executive Summary (TL;DR): PREMs (Patient Reported Experience Measures) are validated questionnaires that capture the patient's perspective on how they experienced their care process: communication, treatment, coordination, wellbeing, and the empowerment they received. They do not measure whether the patient is satisfied (that is what satisfaction surveys do), but rather what actually happened during care, from the perspective of the person who received it. They are an essential tool in Value-Based Healthcare (VBHC) and, together with PROMs, form the core of patient-centred measurement.

Riccardo Begelle, 2026

10 min

What are PREMs? A Clear and Complete Definition

PREMs, an acronym for Patient Reported Experience Measures, are standardised and validated measurement instruments that collect directly from the patient their perception of the healthcare received during a specific care process.

Unlike traditional clinical indicators — which measure what the system does — PREMs measure how the patient experiences it. This distinction is fundamental: a process can be clinically impeccable and, at the same time, generate a poor experience in terms of communication, treatment, or coordination.

""Patient experience is the sum of all interactions, shaped by an organisation's culture, that influence patient perceptions across the continuum of care."

— The Beryl Institute — international reference for patient experience (cited in the SECA Guide for VBHC Implementation, 2025)"

This definition from the Beryl Institute — the most influential internationally — underlines that patient experience is not reduced to a single appointment or the relationship with a particular doctor. It is the accumulated result of all interactions: from the first call to book an appointment to discharge or subsequent follow-up. PREMs are precisely the tool designed to capture that experience in a systematic, quantifiable, and comparable way.

NXTRA

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In practice, PREMs take the form of structured questionnaires — typically brief, with between 10 and 25 questions — that patients complete shortly after receiving care. They can be administered on paper, by SMS, email, QR code, or through specialised digital platforms such as RateNow.

What Do PREMs Measure Exactly? The 6 Key Dimensions

PREMs do not measure a single aspect of care: they address experience as a multidimensional phenomenon. According to the Guide for the Implementation of Value-Based Healthcare (SECA, 2025), in whose development the IEXP and RateNow participated, at least six standard dimensions can be identified that every good PREM questionnaire should cover:

Dimension	What It Measures
Comprehension	Whether the patient and their companion have understood information about their condition, the medical process, and its implications. Includes in-person, digital, and printed explanations.
Treatment	Whether the healthcare professional has been respectful, adapted their language, and taken into account the needs of the patient and their environment.
Trust	The level of closeness and trust that healthcare staff have built with the patient and their family throughout the process.
Empowerment	Whether the patient has gained the skills and knowledge needed to better manage their condition and improve their health habits.
Emotional wellbeing	The organisation's capacity to provide emotional support to the patient and prevent the illness from taking centre stage in their life.
Availability and accessibility	The ease with which the patient can contact the right people, resolve queries, and carry out administrative tasks efficiently.

These six dimensions are not independent: they reinforce each other. A patient who understands their process well (comprehension) and receives good treatment is better placed to adhere to treatment and participate in shared decision-making, which in turn improves their health outcomes — what we measure with PROMs.

Key finding for quality teams

Research published in BMC Health Services Research (De Rosis et al., 2020) found that in the Tuscany and Veneto regions of Italy, the continuous use of PREMs with machine learning analysis reduced the number of hospital complaints and systematically identified both failures and good practices that patients rarely communicate through other channels.

What are PREMs For? Utility at Three Levels of Management

One of the most common mistakes when implementing PREMs is seeing them solely as a reporting tool for senior management. Their real value unfolds simultaneously at three levels:

Macro level: health system and health policy

PREMs provide health authorities with population-based data to prioritise interventions, evaluate policies, and allocate resources informed by the patient's perspective — not just clinical or financial data. They are one of the pillars of Quintuple Aim measurement, the framework of five objectives for modern healthcare that explicitly includes improving patient experience as a goal.

Meso level: organisational and hospital management

They enable management teams to assess the relative performance of units, services, or teams from the patient's perspective; identify areas for systemic improvement; and build internal and external benchmarking. PREM data is especially useful for guiding humanisation strategy and designing the patient journey across each care pathway.

Micro level: clinical teams and the care process

Direct and continuous patient feedback allows clinical teams to adjust their practices in real time, identify which moments in the process generate the most friction, and strengthen the therapeutic relationship. When PREM data reaches teams in near-real time — as digital platforms like RateNow enable — continuous improvement becomes part of the standard workflow, rather than a periodic, bureaucratic task.

PREMs in Value-Based Healthcare: Why They Are Indispensable

PREMs are not a passing trend. They are a logical consequence of the Value-Based Healthcare (VBHC) paradigm, the model championed by Michael Porter and Elizabeth Teisberg that defines value in health as the outcomes that matter to patients relative to the cost of achieving them.

Within this framework, measuring exclusively what clinicians do — the so-called CROMs, Clinician Reported Outcome Measures — is insufficient. The value perceived by the patient also depends on how they experienced that process: whether they felt informed, whether they were treated with respect, whether they felt capable of managing their condition. That is precisely what PREMs measure.

""PREMs and PROMs make it possible to identify areas for improvement that clinical indicators and CROMs do not detect, improving care quality from a more empathetic, human, and relational perspective."

— Pérez, A.; Bezos, C.; Begelle, R. — Chapter 2.9, SECA Guide for VBHC Implementation (2025)

The SECA 2025 Guide — the reference work in Spain on VBHC — includes the systematic use of PREMs as one of the essential components of any value implementation programme in healthcare. Together with PROMs, CROMs, and cost data, PREMs complete the measurement framework that any healthcare organisation needs if it wishes to transform its care model.

In Spain, PREM adoption is still at an early stage. According to the Guide, "there is a notable lack of data relating to patient experience, both in relation to their health and quality of life (PROMs) and their relationship with the healthcare system (PREMs)." This represents an opportunity for improvement — and differentiation — for centres that decide to implement them rigorously.

Is Your Centre Already Measuring Patient Experience with PREMs?

RateNow facilitates the continuous collection of PREMs and PROMs with validated questionnaires, digital channels (SMS, email, QR), and real-time analytics. More than 300 healthcare centres across Spain and Europe already measure their patients' experience with our platform.

→ Request a free demo at sales@ratenow.cx

References

1. The Beryl Institute. Patient Experience Definition. Available at: theberylinstitute.org

2. Pérez A, Bezos Daleske C, Begelle R. Tools, facilitators and barriers: Patient-Reported Experience Measures (PREM). In: Varela Rodríguez C (ed.). Guide for the Implementation of Value-Based Healthcare. Madrid: SECA; 2025. Ch. 2.9:373–397.

3. De Rosis S, Cerasuolo D, Nuti S. Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy. BMC Health Serv Res. 2020;20:315.

4. Asociación Madrileña de Calidad Asistencial (AMCA). Guide for the design, implementation and measurement of patient experience in hospitals using PREMs. Madrid: AMCA; 2020.

5. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS). Key elements influencing patient experience (PREM). Barcelona: AQuAS; 2020.

6. Elola Somoza FJ. Context of the National Health System. In: Varela Rodríguez C (ed.). Guide for the Implementation of VBHC. Madrid: SECA; 2025. Ch. 1.1:17–30.

Are PREMs mandatory in Spain?

There is currently no national regulation making them mandatory, although several regional initiatives and the SECA Guide itself recommend them as a key element of care quality.

How many questions should a PREM questionnaire have?

The most widely used PREMs range from 10 to 33 items. The recommendation is that they should not exceed 3–5 minutes to complete, in order to maximise response rates.

Can the same PREMs be used in A&E, inpatient wards, and outpatient clinics?

No. Each care setting requires a PREM questionnaire adapted and validated for its specific context. The experience of a patient in A&E is radically different from that of an inpatient.

Are PREMs anonymous?

Generally yes, to avoid bias and protect patient privacy. Some platforms allow voluntary traceability for patients who wish to receive a personalised response.

What is a second-generation PREM?

These are dynamic PREMs, designed with digital technology, that adapt to the patient's context in real time and allow continuous validation in line with organisational changes.