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Patient Experience, GuideWhat are PROMs? The Definitive Guide on Patient Reported Outcome Measures
How validated questionnaires measure symptoms, quality of life and functionality directly from the patient's voice.
PROMs (Patient Reported Outcome Measures) are standardised and validated questionnaires that collect directly from the patient their perception of the outcomes of their disease and the treatment received: symptoms, quality of life, functionality and wellbeing.
They do not measure how the patient experienced the care process (that is what PREMs do), but rather the real impact of the disease and care on their daily life.
They are an essential tool in Value-Based Healthcare (VBHC) and, together with PREMs and CROMs, form the complete patient-centred outcomes measurement system.
Riccardo Begelle, 2026 
15 min 
What are PROMs? A Clear and Complete Definition
PROMs, an acronym for Patient Reported Outcome Measures, are standardised and validated questionnaires that allow the collection of the patient's perception of their symptoms, quality of life, functionality and wellbeing, without any professional interpreting or filtering that information.
The key to PROMs lies in their origin: the data is generated by the patient themselves. This characteristic distinguishes them from traditional clinical indicators and makes them the only way to capture dimensions of health that would otherwise remain invisible in the medical record.
""PROMs are generally standardised and validated questionnaires that allow the collection of the patient's perception of their symptoms, quality of life, functionality and wellbeing."
— Grossat, E.; Varela Rodríguez, C. — Chapter 2.8, SECA Guide for the Implementation of VBHC (2025)"
— Grossat, E.; Varela Rodríguez, C. — Chapter 2.8, SECA Guide for the Implementation of VBHC (2025)"
This definition, taken from the Guide for the Implementation of Value-Based Healthcare (SECA, 2025), underlines two fundamental aspects: standardisation, which allows results to be compared between patients, centres and countries; and validation, which ensures that the questionnaire actually measures what it claims to measure.
There are relevant differences between what professionals' reports capture and what patients themselves describe about their health. These discrepancies may be due to the professional's scientific-technical interpretation, the lack of time during consultations, or the fact that the patient does not mention certain symptoms for fear of overburdening the clinician or having their treatment modified. PROMs solve this problem at the root: it is the patient who reports, in their own terms, how they are feeling.
PROMs vs CROMs: Two Complementary Perspectives on the Same Reality
Health outcomes can be observed from two different angles:
PROM (Patient Reported): the patient reports their symptoms, quality of life and wellbeing. It captures the subjective: the pain they feel, the fatigue they experience, the ability to lead a normal life.
CROM (Clinician Reported): the clinician records objective signs such as laboratory parameters, disease activity scales, and diagnostic test data.
Neither replaces the other. The integration of PROMs and CROMs provides a multidimensional view of the care process that combines the objective and the subjective to assess the true value of healthcare.
What do PROMs Measure? The 4 Key Dimensions of Patient Outcomes
PROMs are not a single questionnaire: they are a family of instruments designed to measure different dimensions of how disease and treatment affect the patient's life. According to the SECA Guide 2025, health outcomes are a multidimensional concept encompassing four main areas:
| Dimension | What it measures | Examples of PROMs |
|---|---|---|
| Symptoms | The patient's subjective perception of manifestations of their disease that only they can describe: pain, fatigue, nausea, dyspnoea, anxiety. | PROMIS Pain Intensity, PHQ-9, FACIT-Fatigue |
| Health-related quality of life | The overall impact of the disease on the patient's physical, mental and social wellbeing and their ability to lead a fulfilling life. | SF-36, EQ-5D, WHOQOL-BREF |
| Functionality | The patient's ability to carry out daily activities: walking, working, socialising, being self-sufficient. | HAQ (arthritis), KOOS (knee), PROMIS Physical Function |
| Psychological wellbeing | The emotional impact of the disease: levels of depression, anxiety, stress and general mental wellbeing. | GAD-7, PHQ-9, PROMIS Emotional Distress |
This multidimensional structure explains why a patient may have controlled clinical parameters (CROM within normal range) while at the same time reporting poor quality of life or very limited functionality. Without PROMs, that gap remains invisible to the clinical team.
Key clinical evidence
In the trial at the Centre Jean Bernard (France) with advanced lung cancer patients, the group monitored via weekly online PROMs achieved a one-year survival rate of 74.9% compared to 48.5% in the conventional follow-up group with periodic CT scans. Median survival was 22.5 months vs. 14.9 months.
86% of patients in the PROM group generated at least one alert that triggered a call from the oncologist and led to additional supportive care.
Source: Denis et al., JAMA, 2019 — cited in SECA Guide 2025, Ch. 2.8.
Types of PROMs: Generic vs Condition-Specific
Not all PROMs are the same. Choosing the right instrument is one of the most critical steps in any health outcomes measurement programme. PROMs are classified mainly into two broad categories:
Generic PROMs
Generic PROMs measure health status and quality of life in a cross-sectional way, without focusing on a specific disease. Their advantage is that they allow results to be compared across different clinical conditions, populations and healthcare systems. They are particularly useful for public health studies, economic evaluations and benchmarking between centres.
The most widely used internationally are the SF-36 (36 items, 8 health dimensions), the EQ-5D (5 dimensions + visual analogue scale, widely used in health economic evaluation), the SF-12 (abbreviated version of the SF-36 for large studies) and PROMIS (a modern system from the US NIH with adaptive item banks).
Condition-Specific PROMs
Condition-specific PROMs are designed and validated for a specific disease or therapeutic area. They capture dimensions that are relevant to that particular condition and which generic instruments do not capture with sufficient sensitivity. They are more useful for routine clinical practice, individualised patient follow-up and specialised clinical research.
Common examples: KOOS and WOMAC for knee and hip joint pathology, HAQ for rheumatoid arthritis, EORTC QLQ-C30 for oncology, IPSS for prostate pathology, and specific questionnaires for asthma, COPD, heart failure and multiple sclerosis.
Which to Choose? Quick Decision Criteria
Use a generic PROM when you need to compare results across different pathologies, evaluate the impact of health policies, or calculate quality-adjusted life years (QALYs) for cost-effectiveness analyses.
Use a condition-specific PROM when you want to carry out individualised clinical follow-up, detect relevant changes for that specific patient, or participate in benchmarking with other centres treating the same condition.
In many excellence programmes, both are used in parallel: the generic one for comparability and the specific one for clinical sensitivity.
PROMs in Clinical Practice: What the Evidence Says
The evidence accumulated over the last two decades on the impact of PROMs in clinical practice is solid and growing. The SECA Guide 2025 compiles the main findings by therapeutic area:
Oncology
Systematic reviews have shown that PROMs improve clinician-patient communication, allow detection of symptoms not reported during consultations, and are associated with better overall survival in patients with advanced cancer. The use of electronic systems to administer PROMs and communicate this information to physicians improves symptom control, physical function, quality of life and treatment adherence, and reduces emergency and hospital admissions.
Rheumatology
Initiatives such as OMERACT and EULAR have promoted the systematic incorporation of PROMs — fatigue, pain, morning stiffness — alongside CROMs such as the DAS28, improving monitoring and comparability of results. ePROMs have been associated with a reduction in disease activity compared to traditional follow-up models, and are a faster, more efficient and lower-cost alternative to paper formats.
Beyond the Hospital: PROMs in Primary Care and Chronic Diseases
Evidence of the impact of PROMs extends equally to primary care, cardiology, mental health and chronic respiratory diseases. In all these contexts, studies show a consistent pattern: integrating PROMs into routine clinical practice improves communication between patient and professional, allows unmet needs to be detected, and is associated with greater efficiency in resource use.
""Monitoring symptoms through PROMs offers an evidence-based approach to detecting symptoms that can provide critical information to physicians, thereby improving clinical management."
— Grossat, E.; Varela Rodríguez, C. — Chapter 2.8, SECA Guide for the Implementation of VBHC (2025)
— Grossat, E.; Varela Rodríguez, C. — Chapter 2.8, SECA Guide for the Implementation of VBHC (2025)
PROMs in Value-Based Healthcare: The Missing Link
Value-Based Healthcare (VBHC), the paradigm championed by Michael Porter since 2010, defines value in health as the outcomes that matter to the patient in relation to the cost of achieving them. Within this framework, PROMs are not optional: they are the instrument that makes it possible to measure the most important half of the equation.
Without PROMs, health systems can only measure what clinicians do and objective biomedical outcomes. But the true impact of care on the patient's life — whether they can work, whether they sleep well, whether they are in pain, whether they feel capable of managing their illness — remains invisible. PROMs illuminate exactly that blind spot.
International reference organisations have been systematising their use around this paradigm for over a decade. ICHOM (International Consortium for Health Outcomes Measurement) has developed more than 40 standardised sets of outcome measures since 2012 — known as standard sets — for conditions such as breast cancer, diabetes, heart failure, depression and arthritis. Each one integrates PROMs and CROMs selected by consensus among clinicians, researchers and patient associations.
Despite this evidence, integrating PROMs into routine clinical practice — outside clinical trials and pilot projects — remains a challenge in most healthcare systems. The main barriers identified at international level are healthcare overload, lack of interoperability with electronic health records, and the perception of PROMs as an additional administrative burden.
Is Your Centre Already Measuring Outcomes with PROMs?
RateNow facilitates the continuous collection of PROMs and PREMs with validated questionnaires, digital channels (SMS, email, QR) and real-time analytics. It integrates PROMs into the routine clinical workflow without increasing the team's administrative burden.
→ Request a free demo at sales@ratenow.cx
References
1. Grossat E, Varela Rodríguez C. Tools, facilitators and barriers in the use of health outcome indicators: CROM and PROM. In: Varela Rodríguez C (ed.). Guide for the Implementation of Value-Based Healthcare. Madrid: SECA; 2025. Ch. 2.8:355-372.
2. Black N. Patient reported outcome measures could help transform healthcare. BMJ. 2013;346:f167.
3. Denis F, Basch E, Septans AL, et al. Two-year survival comparing web-based symptom monitoring vs routine surveillance following treatment for lung cancer. JAMA. 2019;321(3):306-7.
4. International Consortium for Health Outcomes Measurement (ICHOM). Standard Sets. Boston: ICHOM; 2012. Available at: ichom.org/standard-sets
5. Mokkink LB, Terwee CB, Patrick DL, et al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27(5):1147-57.
6. Basch E, et al. Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment. J Clin Oncol. 2016;34(6):557-65.
7. International Consortium for Health Outcomes Measurement (ICHOM). Standard Sets overview. Boston: ICHOM; 2012. Available at: ichom.org/standard-sets
Are PROMs and PREMs the same thing?
No. PROMs measure the patient's health outcomes (symptoms, quality of life, functionality). PREMs measure how the patient experienced the care process (communication, treatment, coordination). They are complementary: together they offer the complete picture of value as perceived by the patient.
When are PROMs administered?
It depends on the objective. In routine clinical practice, before each visit to prepare the consultation. In chronic disease follow-up, periodically (monthly, quarterly). In research or clinical trials, according to the defined protocol.
What are ePROMs?
PROMs administered in electronic format: via web, mobile application, SMS or automated call. Studies show that ePROMs are faster, cheaper and allow more complete data capture than paper formats, as well as facilitating dynamic adjustment of visits according to the patient's condition.
Is it necessary to validate a PROM before using it?
Yes. A PROM questionnaire is only reliable if it has been psychometrically validated: that it measures what it claims to measure (validity), that it does so in a stable manner (reliability) and that it detects clinically relevant changes (responsiveness). The COSMIN initiative establishes the methodological standards for this validation.
Can PROMs be used in any specialty?
Yes. Although their adoption has been faster in oncology, rheumatology and orthopaedic surgery, there is evidence of their usefulness in virtually all specialties. The key is to choose the right instrument for each condition and clinical context.
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