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Patient Experience, GuidePREM vs PROM: Differences, Similarities and Why You Need Both in Your Healthcare Centre
Two complementary tools that measure different things about the same patient.
The main difference is that PROMs measure the patient's health outcomes (symptoms, quality of life, functionality), while PREMs measure how that patient experienced their care process (treatment, communication, coordination, information).
They are not mutually exclusive: they answer different questions about the same person. PROMs capture the intimate experience of illness. PREMs capture the experience of interacting with the healthcare system. Together they offer the complete picture of value as perceived by the patient.
Riccardo Begelle, 2026 
12 min 
The Origin of the Confusion: Two Tools That Share Initials but Measure Different Things
PREMs and PROMs share three characteristics that explain why they are so frequently confused: both are Patient Reported measures, both are administered through validated questionnaires, and both are key tools in Value-Based Healthcare (VBHC).
But what they measure is radically different, and that difference has direct implications for clinical and management decision-making.
""Patient experience is not limited to the clinical outcome (quality of life, symptomatic improvement), but includes the subjective experience of the care received: trust in the professional, understanding of medical information, perceived empathy and the possibility of shared decision-making."
— Varela Rodríguez, C. — Ch. 1.5, SECA Guide for the Implementation of VBHC (2025)
— Varela Rodríguez, C. — Ch. 1.5, SECA Guide for the Implementation of VBHC (2025)
To understand the fundamental difference between PREMs and PROMs, the SECA Guide 2025 proposes a very useful conceptual framework: the patient's experience within the healthcare system operates at three distinct levels that, although related, are independent of each other:
The Three Levels of Patient Experience (Varela Rodríguez, 2025)
Level 1 — Biological: the symptoms present in the person's health condition. This is the fundamental level that identifies when someone feels ill or well. PROMs operate primarily at this level.
Level 2 — Intimate emotional: how the person experiences their health condition at a personal, family and social level. The day-to-day experience of illness. PROMs also capture dimensions of this level (quality of life, psychological wellbeing).
Level 3 — Interaction with the healthcare system: the experience arising from the relationship with the healthcare organisation: appointments, waiting times, treatment received, information available, professional empathy. This is the level at which PREMs specifically operate.
This distinction is more than theoretical. A patient may have well-controlled symptoms (good PROM result) while at the same time having lived through a care process that was deficient in communication or coordination (poor PREM result). And conversely: they may have received excellent human care (good PREM) but with clinical or quality-of-life outcomes that could be improved (PROMs revealing unmet needs).
PREM vs PROM: Complete Comparison Table
The difference between PREMs and PROMs can be summarised in a structured way. This table is the definitive answer to the question "what does each measure and how do they differ":
| PREM | PROM | |
|---|---|---|
| What does it measure? | How the patient experienced the care process: treatment, communication, coordination, information received, accessibility. | How illness and treatment affect the patient's life: symptoms, quality of life, functionality, wellbeing. |
| Perspective | The interaction with the healthcare system — the external level of the patient's experience. | The intimate experience of illness — the biological and emotional levels of the patient's experience. |
| Type of indicator (Donabedian) | Process indicator: evaluates how care was delivered. | Outcome indicator: evaluates the impact of illness and treatment on the patient's life. |
| Who responds? | The patient, on their interaction with the healthcare system. | The patient, on their health status and quality of life. |
| When is it administered? | Shortly after the care contact (consultation, hospitalisation, A&E...). | Before each visit, periodically during follow-up, or at the beginning and end of a treatment. |
| Example question | "Did the healthcare staff clearly explain the next steps in your care?" | "In the last 7 days, how much pain have you felt?" |
| Typical instruments | PPE-15, IEXPAC, HCAHPS, EUROPEP, process-validated questionnaires (consultations, A&E, hospitalisation, day surgery). | EQ-5D, SF-36, PROMIS, KOOS, EORTC QLQ-C30, HAQ... |
| Are they mutually exclusive? | No. Used in parallel to obtain the complete picture of value as perceived by the patient. | No. Used in parallel to obtain the complete picture of value as perceived by the patient. |
From the perspective of Donabedian's taxonomy — the most widely used conceptual framework in healthcare quality — PREMs are process indicators (they evaluate how care was delivered) while PROMs are outcome indicators (they evaluate the impact of that care on the patient's life). This distinction has direct implications for interpreting data and designing improvement actions.
PREMs and PROMs in Practice: A Real Example
The best way to understand the difference — and complementarity — between PREMs and PROMs is with a concrete case. Let us consider two patients with the same clinical condition: a knee arthroplasty.
Patient A — 3 months after knee arthroplasty
PREM — what we ask about the care received:
"Did they clearly explain what rehabilitation would involve before discharge? Did you know who to contact if you had questions? Did you feel treated with respect during your admission?"
PROM — what we ask about the health outcome:
"How much pain have you felt in your knee during the past week? Can you climb stairs without assistance? Have you been able to resume daily activities such as walking or driving?"
Patient A might report an excellent care experience (high PREM) but with significant persistent pain and functional limitation (PROMs revealing an incomplete recovery). That combined information is far more useful to the clinical team than either piece of data in isolation: it indicates that the care process was correct, but that the rehabilitation protocol or postoperative pain management needs reviewing.
Conversely, Patient B might show rapid functional recovery (favourable PROMs) but report not having received clear information about warning signs or how to manage their recovery at home (PREMs highlighting deficits in communication and patient education). That gap may lead to avoidable readmissions or suboptimal treatment adherence.
What PROMs Do Not Detect That PREMs Do, and Vice Versa
PROMs do not detect: whether the patient felt well informed, whether they had easy access to the team, whether they perceived empathy, whether they participated in decisions about their treatment.
PREMs do not detect: whether pain has improved, whether functionality has been recovered, whether quality of life has changed, whether treatment has had the expected impact on the illness.
The conclusion is inevitable: a healthcare system that only measures PREMs has information about the process but not about outcomes. One that only measures PROMs knows whether the treatment works, but not how the patient is experiencing it. Only by measuring both can health value be managed in an integrated way.
When to Prioritise PREMs, When PROMs and When Both
In clinical and management practice, the choice between PREMs, PROMs or both depends on the measurement objective. Not all organisations need to start measuring everything at once: there is a logic of gradual implementation.
Prioritise PREMs when...
The main objective is to improve care processes, detect friction points in the patient journey, evaluate the humanisation of care, or compare patient experience between services or teams. PREMs are especially valuable in processes with high experiential variability: A&E, hospitalisation, outpatient consultations, day surgery.
Prioritise PROMs when...
The objective is to measure the clinical impact of an intervention, carry out longitudinal follow-up of a chronic condition, participate in benchmarking with other centres using ICHOM standard sets, or generate real-world evidence for clinical and reimbursement decision-making. PROMs are essential in specialities such as oncology, rheumatology, orthopaedic surgery or mental health.
Use both when...
The objective is to implement a complete Value-Based Healthcare programme. In this case, PREMs and PROMs complement each other: PROMs measure whether care produces the expected outcomes in the patient's life; PREMs measure whether that process was consistent with the experiential quality standards the organisation wants to offer. Correlating both datasets allows the identification of which aspects of the care process have the greatest impact on health outcomes — information of enormous value for continuous improvement.
""The systematic measurement of clinical outcomes (CROMs), patient-reported outcomes (PROMs) and patient experience (PREMs) is essential to improve healthcare quality, facilitate decision-making and promote continuous improvement."
— Varela Rodríguez, C. — Ch. 1.5, SECA Guide for the Implementation of VBHC (2025)
— Varela Rodríguez, C. — Ch. 1.5, SECA Guide for the Implementation of VBHC (2025)
PREMs and PROMs Together: How They Integrate in VBHC
In the Value-Based Healthcare model, PREMs and PROMs are not alternative instruments: they are complementary layers of the same measurement system designed to capture the value perceived by the patient in its entirety.
The SECA Guide 2025 describes how a value-oriented healthcare information system integrates objective clinical data (CROMs), patient-reported outcomes (PROMs), the experience of the care process (PREMs) and cost data into a central repository. Only when all these dimensions are integrated is it possible to answer the fundamental question of VBHC: which interventions produce the best outcomes for patients at the lowest cost and with the best experience?
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The correlation between PREMs and PROMs also produces clinically relevant findings. Research in the field of chronic diseases has shown that when patients report better experience in dimensions such as patient education and communication (PREMs), their results in treatment adherence and disease management (PROMs) tend to be better. This suggests that investing in improving the process experience is not only an ethical imperative: it is a strategy with demonstrable impact on health outcomes.
Is Your Centre Measuring PREMs and PROMs in an Integrated Way?
RateNow allows you to collect, analyse and correlate PREMs and PROMs within the same workflow, with validated questionnaires, digital channels and real-time dashboards for clinical and management teams.
→ Request a free demo at sales@ratenow.cx
→ Request a free demo at sales@ratenow.cx
References
1. Varela Rodríguez C, Srur A. Paradigma de la ASBV, evolución de la medición de los resultados en salud, outcomes research y medicina basada en la evidencia. In: Varela Rodríguez C (ed.). Guía para la Implementación de Asistencia Sanitaria Basada en Valor. Madrid: SECA; 2025. Ch. 1.5:101-130.
2. Ruiz López PM, Varela Rodríguez C. Gestión por procesos y atención sanitaria basada en valor. In: Varela Rodríguez C (ed.). Guía para la Implementación de ASBV. Madrid: SECA; 2025. Ch. 1.6:131-150.
3. Grossat E, Varela Rodríguez C. Herramientas, facilitadores y barreras: CROM y PROM. In: Varela Rodríguez C (ed.). Guía para la Implementación de ASBV. Madrid: SECA; 2025. Ch. 2.8:355-372.
4. Pérez A, Bezos Daleske C, Begelle R. Herramientas, facilitadores y barreras: PREM. In: Varela Rodríguez C (ed.). Guía para la Implementación de ASBV. Madrid: SECA; 2025. Ch. 2.9:373-397.
5. Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477-81.
6. International Consortium for Health Outcomes Measurement (ICHOM). Standard Sets. Boston: ICHOM; 2012. ichom.org/standard-sets
Is the main difference between PREMs and PROMs that one measures experience and the other outcomes?
Yes, in essence. PROMs measure the impact of illness and treatment on the patient's life. PREMs measure how the patient experienced the healthcare care process.
Can there be good PROMs with poor PREMs, or vice versa?
Yes, and it is more common than it seems. A patient may recover well from an intervention (good PROMs) but have experienced the process with poor information, poor coordination or inadequate treatment (poor PREMs). And vice versa.
Can the same PREM and PROM questionnaires be used for all clinical conditions?
No. Generic PREMs are useful for comparing experience between services, but process-specific PREMs capture dimensions relevant to each care context. PROMs follow the same logic: generic ones (EQ-5D, SF-36) enable comparison; specific ones (KOOS, EORTC) are more sensitive for particular conditions.
Where to start: PREMs or PROMs?
It depends on the objective. If the priority is to improve processes and experience, start with PREMs. If the priority is to measure the clinical impact of specific treatments or conditions, start with PROMs. The ideal is to implement both progressively, within a coherent measurement strategy.
Is there any questionnaire that measures both PREMs and PROMs at the same time?
There is no single instrument that validly measures both dimensions. They are distinct constructs that require distinct instruments. What does exist are digital platforms that enable the administration and correlation of both types of questionnaires within the same clinical workflow.
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