Evidence-Based Healthcare Research

Patient Experience Research & Evidence

Independent research on patient experience, retention, reputation, quality improvement and financial performance.

Peer-Reviewed LiteratureScholarly Metadata & DOIsHealthcare Organizations

BMJ open quality2026

Organisational responses to patient complaints in healthcare service delivery in low- and middle-income countries: a scoping review

Suleyman Mohammed Arage, Mirkuzie Woldie, Adane Kebede, Lake Yazachew, Asmamaw Atnafu

Systematic Review

INTRODUCTION: Patient complaints reveal gaps in quality, safety and patient-centred care, yet many low- and middle-income countries (LMICs) health systems respond inadequately, resulting in dissatisfaction, disengagement and ongoing service problems. OBJECTIVES: This scoping review maps the causes of patient complaints, evaluates existing organisational response mechanisms and policies and identifies gaps in the current evidence. METHODS: The study was conducted following the Joanna Briggs Institute scoping review methodology. It focused on the causes of complaints, organisational response mechanisms, existing policies and frameworks, limitations and recommendations identified in the literature. A comprehensive search was conducted across PubMed, Embase, Web of Science, Scopus, the Cochrane Library, Advanced Google Scholar and other grey literature sources. Study selection and screening were performed using Rayyan software, with two independent reviewers applying predefined eligibility criteria. Data were extracted using a standardised table and the findings were presented through tables, graphs and narrative synthesis. Reporting adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for Scoping Reviews (PRISMA-ScR) guidelines. RESULTS: The review includes 37 studies from various regions. These studies found that the main cause of complaint was categorised into five main domains, mainly management, followed by relationship, clinical, environmental, patient rights and others. Moreover, regarding response mechanisms, the review highlights complaint response mechanisms in healthcare that operate across three interlinked levels: national, institutional and frontline care, each with distinct approaches. Furthermore, regarding policy, the review showed that there are a few national-level and institutional-level policies on complaint handling. However, there needs to be greater focus on methodological diversity research in LMIC, as suggested by the literature on limitations and recommendations. CONCLUSIONS: This scoping review identified gaps in evidence on patient complaints, organisational responses and policies, providing a foundation for research on healthcare complaints in LMICs.

Why This Matters:Provides empirical clinical evidence from BMJ open quality regarding Patient Satisfaction outcomes.

Patient Satisfaction

Psycho-Oncology2026

From Clinical Reality to Blueprint Designing: A Qualitative Study Exploring Communication Challenges and Unmet Needs for Patient Decision Aid Development in Early‐Stage Breast Cancer

Serena Sdinami, Martina Maialetti, Valeria Sebri, Paola Zagami, Roberto Grasso, Giuseppe Curigliano, Gabriella Pravettoni

Qualitative Study

ABSTRACT Introduction A diagnosis of early‐stage Breast Cancer (BC) induces significant psychological distress in patients, who are then required to make complex treatment decisions. Evidence‐based tools like Patient Decision Aids (PDAs) have been proposed as tools to support communication and Shared Decision‐Making (SDM). However, their successful use in clinical practice depends also on real‐world consultation dynamics. Existing literature suggests that insufficient attention to contextual and user‐centered factors may limit the relevance and uptake of PDAs. A bottom‐up approach grounded in clinical reality may therefore be essential to inform their design and future integration into care. Aims This study aimed to explore experiences, unmet needs and expectations of both patients and healthcare professionals involved in early‐stage breast cancer care regarding decision‐making support and standard oncological consultations, in order to identify patient‐ and clinician‐derived design requirements for a future PDA supporting shared treatment decision‐making in early‐stage breast cancer. Methodology We conducted 52 semi‐structured interviews with 20 patients and 32 HCPs at the European Institute of Oncology in Milan from 10 January 2025 to 30 August 2025. Interviews were transcribed and analyzed using thematic analysis, with coding performed by two independent researchers and discrepancies resolved through independent discussion with two other authors. Results HCPs highlighted three key themes: variability in patient information needs, misconceptions about treatments (especially chemotherapy and radiotherapy), and the multifactorial nature of treatment decisions. Patients emphasized the importance of trust in physicians, the need for practical information on side effects and coping strategies, and the role of peer support, often found through informal networks or social media. These findings identified preliminary requirements for a future PDA: adaptable information depth and timing; plain‐language responses to common misconceptions; structured values‐clarification prompts; practical preparation and side‐effect‐management information; signposting to vetted psychosocial and peer‐support resources. Conclusions Findings highlight communication challenges and unmet psychosocial and informational needs within standard oncological consultations for early‐stage breast cancer. By grounding decision support development in the perspectives of both patients and healthcare professionals, this study provides formative, pre‐implementation insights to guide the design of PDAs that are responsive to real‐world clinical contexts and patient experiences. Trial Registration clinicaltrials.gov , identifier: NCT06762496. Registered 7th January 2025 – https://clinicaltrials.gov/study/NCT06762496

Why This Matters:Provides empirical clinical evidence from Psycho-Oncology regarding Patient Experience outcomes.

Patient Experience

Journal of medical Internet research2026

Association Between Physician Communication Features and Patient Outcomes in Telemedicine: Retrospective Cross-Sectional Observational Study

Yipei Wang, Shu Wang, Ke Zhang, Zhijie Liu, Qingbian Ma, Hong Ji, Zheng Hou, Tracy Xiao Liu, Xuedong Xu, Xinxia Wu, Changxiao Jin

Cross-Sectional Study

BACKGROUND: Asynchronous telemedicine is a crucial component of multichannel health care, where effective communication drives satisfaction. However, the effectiveness of communication features remains poorly understood. Prior research relied on subjective surveys or small-scale simulations, failing to link features to objective outcomes. Understanding these features is critical for optimizing physician engagement and establishing quality indicators to enhance the patient experience. OBJECTIVE: This study aimed to bridge this gap by leveraging a large-scale real-world dataset to quantify the association between physicians' communication features-including response modalities, length, and sequence-and patient repurchase behavior, as well as review scores, within a high-autonomy health care setting. METHODS: This retrospective cross-sectional study analyzed 304,337 paid, patient-initiated virtual visits from a Chinese academic medical center (2021-2023), which included 823,135 physician responses. The sample was selected after applying a series of exclusion criteria, such as free consultations, team-based visits, and outlier data. The key exposures were the modality of physician responses, response length, and response sequence. Outcomes included patient loyalty and satisfaction. Loyalty was operationalized as follow-up visits within 6 months, with a 30-day exclusion period applied to same-physician (fv1) and same-department (fv2) revisits to filter out clinical necessity, but not to hospital-wide revisits (fv3). Satisfaction was measured by the review scores. We used probit and ordinary least squares regressions to examine the relationships between communication features and patient outcomes. RESULTS: Regarding loyalty, audio-only visits were associated with the lowest fv1, with an average marginal effect (AME) of -0.030 (95% CI -0.043 to -0.016, P<.001), translating to a 30.9% (0.030/0.097) reduction compared to text-only visits. Regarding satisfaction, audio messages were associated with a significantly increased likelihood of patients providing reviews, with an AME of 0.041 (95% CI 0.006-0.076, P=.02), but they did not affect review scores after adjusting for inverse Mills ratios. Increased numbers of text and audio replies were (marginally) associated with improved fv1, with AMEs of 0.009 (95% CI 0.006-0.011, P<.001) and 0.007 (95% CI -0.000 to 0.016, P=.06), respectively. Visits beginning with a sub-5-second audio response and ending with text had significantly higher fv1 than text-only visits, with an AME of 0.069 (95% CI 0.018-0.120, P=.008). The same patterns hold for fv2 and fv3. Based on the Bonferroni test, coefficients with a P value smaller than α=.050/3=.017 or α=.50/2=.025 were regarded as significant when evaluating the association with patient loyalty or satisfaction, respectively. CONCLUSIONS: Physician communication practices were significantly associated with patient loyalty and satisfaction. This study is innovative in leveraging large-scale real-world data to systematically examine physician communication. It differs from existing studies by transcending prior survey-based research limitations. It introduces an effective hybrid approach, balancing human connection with text clarity in the field. Its implication in the real world is providing data-driven evidence to guide clinicians and policymakers in designing high-quality telemedicine services.

Why This Matters:Provides empirical clinical evidence from Journal of medical Internet research regarding Patient Experience outcomes.

Patient Experience

Healthcare (Basel, Switzerland)2026

Driving Revisit Intentions Through Medical Information and Service Quality in General Hospitals: An Extended Technology Acceptance Model Approach

Jebum Kim, SangYoon Lim

BACKGROUND: As Information and Communication Technology (ICT) advances, the healthcare market is shifting toward a consumer-centered paradigm. This study analyzes the structural relationships between medical information quality, medical service quality, and Technology Acceptance Model (TAM) variables to determine their impact on patient satisfaction and revisit intentions in a general hospital context. METHODS: An online survey was conducted with 376 consumers who had experience using general hospitals in South Korea between June and December 2024. Data were analyzed using structural equation modeling (SEM) with SPSS 29.0 and AMOS 29.0. Ethical measures, including informed consent and anonymity, were strictly followed. RESULTS: Findings indicate that among medical information quality factors, accuracy significantly enhanced perceived usefulness, while timeliness positively influenced perceived ease of use. Regarding medical service quality, both accessibility and responsiveness significantly improved both usefulness and ease of use, with responsiveness being the most powerful predictor of ease of use (β = 0.655). While both TAM variables significantly increased patient satisfaction, only perceived ease of use and satisfaction directly drove revisit intentions; perceived usefulness influenced revisit intention only through the mediation of satisfaction. CONCLUSIONS: Patient satisfaction is a paramount factor directly influencing loyalty. Healthcare administrators should prioritize the accuracy and timeliness of digital health information while improving service responsiveness to enhance long-term hospital competitiveness in the proactive consumer era.

Why This Matters:Provides empirical clinical evidence from Healthcare (Basel, Switzerland) regarding Patient Satisfaction outcomes.

Patient Satisfaction

International emergency nursing2026

Patient loyalty in the emergency department: An extended SERVPERF approach comparing first-visit and return patients

Chia-Ching Chen, Yao-Te Tsai, Wen-Chun Chen

BACKGROUND: Emergency departments (EDs) often experience unpredictable patient flows, high-stress environments, and asymmetric information, which make it highly challenging for hospitals to establish patient trust and loyalty and protect their reputations. This study investigated which service quality indicators would affect patient loyalty and the differential impact of service quality on loyalty among first-visit and return patients, a critical distinction in patient relationship management. METHODS: Responses from 199 emergency patients were collected from the emergency department of a regional hospital in central Taiwan. A two-phase analytical approach was employed. First, Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to validate the extended SERVPERF model and analyze the influence of service quality on patient loyalty. Second, the Brunner-Munzel test was used to examine differences between first-visit and return patients. RESULTS: The results showed that assurance (β = 0.268, p < 0.001) was the most critical construct of medical service quality. Medical service quality significantly affected both revisits (β = 0.268 = 0.587) and word-of-mouth (WOM) intention (β = 0.222). First-visit patients exhibited a significantly higher WOM intention (p < 0.01), whereas return patients showed a significantly higher revisit intention (p < 0.01). CONCLUSION: This study confirmed that medical service quality is a key driver of patient loyalty in the ED. This study provides the first empirical evidence that first-visit and return patients form loyalty through different pathways (WOM versus retention), offering a new perspective on developing targeted patient relationship management strategies.

Why This Matters:Provides empirical clinical evidence from International emergency nursing regarding Patient Satisfaction outcomes.

Patient Satisfaction

BMJ quality & safety2026

From complaint material to quality improvement: Exploring the use of patient complaints or compensation claims in quality improvement initiatives-a scoping review

Sebrina Maj-Britt Hansen, Mette Kring Clausen, Nana Roust Hansen, Mette Brandt Eriksen, Anne Kragh Sørensen, Søren Bie Bogh, Søren Fryd Birkeland, Lars Morsø

Systematic Review

BACKGROUND: There is increasing interest in how patient complaint material can be used to highlight areas requiring quality improvement (QI) in healthcare. However, knowledge of using complaint material to initiate or monitor QI is limited. OBJECTIVES: This review explored the use of complaint material in QI by identifying problems related to substandard care that were addressed by QI initiatives, exploring how complaint material was used before or after a QI initiative, and mapping changes in complaint material after QI initiatives. METHODS: This scoping review followed the Joanna Briggs Institute methodology and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews reporting guideline. ELIGIBILITY CRITERIA: Studies were included if a QI initiative was initiated or monitored using complaint material. Eligible designs included observational studies, QI projects, pre-intervention and post-intervention studies and randomised controlled trials. Audio, online and symptom-based complaints were excluded. INFORMATION SOURCES: A systematic search was conducted on 10 December 2024 in Embase, Medline, CINAHL and Web of Science, and additional sources, with no language or date limitations. SYNTHESIS OF RESULTS: Substandard problems targeted by QI initiatives were categorised using the Healthcare Complaints Analysis Tool by two independent coders. Findings were synthesised narratively and summarised using frequency analyses where applicable. RESULTS: We identified 58 QI initiatives, most frequently targeting safety (n=39). Before QI, complaint material was usually analysed through review (n=19), counts (n=17), content categorisation (n=9) or root cause analysis (n=2). After QI, analyses included counts (n=34), rates (n=20), content categorisation (n=7) and review (n=4). Reviewing or categorisation methods were often unspecified. Among studies using complaints as an outcome, most reported complaint reductions (n=43), while a few reported increases (n=2) or mixed results (n=4). DISCUSSION: The QI initiatives primarily targeted patient safety and applied simple quantitative analyses. Some studies relied on reviews or categorisations without reporting the validation or reliability of the used tools. Improved reporting standards are needed to strengthen learning. Furthermore, while QI initiatives appear to have the potential to change complaint patterns, this finding should be interpreted with caution, as this is based on a scoping review. OTHER: Preregistered protocol: https://osf.io/6g4qw.

Why This Matters:Provides empirical clinical evidence from BMJ quality & safety regarding Patient Satisfaction outcomes.

Patient Satisfaction

Healthcare (Basel, Switzerland)2026

Online Patient Reviews for Continuous Quality Improvement: Topic Modeling of Hospital Service Quality in Taiwan and the United States

Sheng-Hsun Hsu, Shwu-Fen Chiu

Background/Objectives: Continuous quality improvement (CQI) requires timely, patient-centered evidence on how people experience healthcare delivery. Structured surveys provide important benchmarks, but their predetermined items may miss emerging or system-specific concerns. This study assesses whether unsolicited online patient reviews can serve as a scalable patient-experience data source for identifying hospital service quality priorities across contrasting healthcare systems. Methods: We analyzed 8247 Google Maps hospital reviews posted in 2024, including 5007 Chinese-language reviews from 24 Taiwanese medical centers and 3240 English-language reviews from 21 large U.S. referral hospitals. Separate language-specific preprocessing pipelines and Latent Dirichlet Allocation (LDA) topic models identified patient-salient service quality dimensions in each country. Cross-lingual semantic mapping then distinguished universal dimensions from system-specific concerns, and star-rating differences across semantically equivalent dimensions were compared. Results: Seven service quality dimensions emerged in each country: five were cross-nationally shared (emergency care, positive care experience, professional medical team, administrative process, and inpatient/treatment care), and each system had two system-specific dimensions. Taiwanese reviews foregrounded service attitude and facility/environment quality, while U.S. reviews foregrounded billing/insurance and clinic systems/access. Ratings for emergency care and administrative process were consistently low across both systems, whereas ratings for the professional medical team were substantially higher in U.S. reviews. Conclusions: Online patient reviews can complement formal patient-experience instruments by revealing actionable CQI priorities that are both universal and context dependent. Emergency care and administrative efficiency represent shared improvement needs across both systems. System-specific interventions include interpersonal training and infrastructure investment in high-utilization single-payer settings, and billing transparency and care coordination in fragmented multi-payer systems. Institutional structures appear to play a more prominent role than cultural factors in shaping which service quality dimensions emerge, though both forces contribute. Established frameworks may inadequately capture system-specific patient concerns.

Why This Matters:Provides empirical clinical evidence from Healthcare (Basel, Switzerland) regarding Patient Experience outcomes.

Patient Experience

BMJ open quality2026

Understanding online hospital patient reviews: a nationwide cross-sectional analysis of polarity, actionability and themes

Siu Yu Zoe Lau, Matthew P Tse, Irfan Dhalla, Dhruv Nayyar

Cross-Sectional Study

BACKGROUND: Patient experience data can support hospital quality improvement initiatives. Unsolicited online hospital reviews have emerged as an alternative data source in addition to traditional survey methods. However, the content and actionability of qualitative online reviews for Canadian hospitals are unknown. METHODS: We conducted a nationwide cross-sectional study analysing Google Review text comments of Canadian acute care hospitals from 2017 to 2022. We analysed a random sample of 1000 comments from June 2017 to June 2022. We characterised the polarity, actionability and thematic content of these comments. RESULTS: Patients were more likely to leave negative reviews (47.9%) than mixed (19.8%) or positive (32.3%) reviews. Most reviews (74.0%) were semiactionable or very actionable. Negative or mixed reviews were generally more actionable than positive reviews (p<0.001). Lastly, patients were most likely to comment on interpersonal interactions with staff and wait times for care. CONCLUSIONS: Qualitative online patient reviews contain actionable feedback. This can provide a source of real-time data to monitor and improve on patient experience.

Why This Matters:Provides empirical clinical evidence from BMJ open quality regarding Patient Experience outcomes.

Patient Experience

Psycho-oncology2026

From Clinical Reality to Blueprint Designing: A Qualitative Study Exploring Communication Challenges and Unmet Needs for Patient Decision Aid Development in Early-Stage Breast Cancer

Serena Sdinami, Martina Maialetti, Valeria Sebri, Paola Zagami, Roberto Grasso, Giuseppe Curigliano, Gabriella Pravettoni

Qualitative Study

INTRODUCTION: A diagnosis of early-stage Breast Cancer (BC) induces significant psychological distress in patients, who are then required to make complex treatment decisions. Evidence-based tools like Patient Decision Aids (PDAs) have been proposed as tools to support communication and Shared Decision-Making (SDM). However, their successful use in clinical practice depends also on real-world consultation dynamics. Existing literature suggests that insufficient attention to contextual and user-centered factors may limit the relevance and uptake of PDAs. A bottom-up approach grounded in clinical reality may therefore be essential to inform their design and future integration into care. AIMS: This study aimed to explore experiences, unmet needs and expectations of both patients and healthcare professionals involved in early-stage breast cancer care regarding decision-making support and standard oncological consultations, in order to identify patient- and clinician-derived design requirements for a future PDA supporting shared treatment decision-making in early-stage breast cancer. METHODOLOGY: We conducted 52 semi-structured interviews with 20 patients and 32 HCPs at the European Institute of Oncology in Milan from 10 January 2025 to 30 August 2025. Interviews were transcribed and analyzed using thematic analysis, with coding performed by two independent researchers and discrepancies resolved through independent discussion with two other authors. RESULTS: HCPs highlighted three key themes: variability in patient information needs, misconceptions about treatments (especially chemotherapy and radiotherapy), and the multifactorial nature of treatment decisions. Patients emphasized the importance of trust in physicians, the need for practical information on side effects and coping strategies, and the role of peer support, often found through informal networks or social media. These findings identified preliminary requirements for a future PDA: adaptable information depth and timing; plain-language responses to common misconceptions; structured values-clarification prompts; practical preparation and side-effect-management information; signposting to vetted psychosocial and peer-support resources. CONCLUSIONS: Findings highlight communication challenges and unmet psychosocial and informational needs within standard oncological consultations for early-stage breast cancer. By grounding decision support development in the perspectives of both patients and healthcare professionals, this study provides formative, pre-implementation insights to guide the design of PDAs that are responsive to real-world clinical contexts and patient experiences. TRIAL REGISTRATION: clinicaltrials.gov, identifier: NCT06762496. Registered 7th January 2025 -https://clinicaltrials.gov/study/NCT06762496.

Why This Matters:Provides empirical clinical evidence from Psycho-oncology regarding Patient Experience outcomes.

Patient Experience

Psycho-oncology2026

From Clinical Reality to Blueprint Designing: A Qualitative Study Exploring Communication Challenges and Unmet Needs for Patient Decision Aid Development in Early-Stage Breast Cancer

Serena Sdinami, Martina Maialetti, Valeria Sebri, Paola Zagami, Roberto Grasso, Giuseppe Curigliano, Gabriella Pravettoni

Qualitative Study

INTRODUCTION: A diagnosis of early-stage Breast Cancer (BC) induces significant psychological distress in patients, who are then required to make complex treatment decisions. Evidence-based tools like Patient Decision Aids (PDAs) have been proposed as tools to support communication and Shared Decision-Making (SDM). However, their successful use in clinical practice depends also on real-world consultation dynamics. Existing literature suggests that insufficient attention to contextual and user-centered factors may limit the relevance and uptake of PDAs. A bottom-up approach grounded in clinical reality may therefore be essential to inform their design and future integration into care. AIMS: This study aimed to explore experiences, unmet needs and expectations of both patients and healthcare professionals involved in early-stage breast cancer care regarding decision-making support and standard oncological consultations, in order to identify patient- and clinician-derived design requirements for a future PDA supporting shared treatment decision-making in early-stage breast cancer. METHODOLOGY: We conducted 52 semi-structured interviews with 20 patients and 32 HCPs at the European Institute of Oncology in Milan from 10 January 2025 to 30 August 2025. Interviews were transcribed and analyzed using thematic analysis, with coding performed by two independent researchers and discrepancies resolved through independent discussion with two other authors. RESULTS: HCPs highlighted three key themes: variability in patient information needs, misconceptions about treatments (especially chemotherapy and radiotherapy), and the multifactorial nature of treatment decisions. Patients emphasized the importance of trust in physicians, the need for practical information on side effects and coping strategies, and the role of peer support, often found through informal networks or social media. These findings identified preliminary requirements for a future PDA: adaptable information depth and timing; plain-language responses to common misconceptions; structured values-clarification prompts; practical preparation and side-effect-management information; signposting to vetted psychosocial and peer-support resources. CONCLUSIONS: Findings highlight communication challenges and unmet psychosocial and informational needs within standard oncological consultations for early-stage breast cancer. By grounding decision support development in the perspectives of both patients and healthcare professionals, this study provides formative, pre-implementation insights to guide the design of PDAs that are responsive to real-world clinical contexts and patient experiences. TRIAL REGISTRATION: clinicaltrials.gov, identifier: NCT06762496. Registered 7th January 2025 -https://clinicaltrials.gov/study/NCT06762496.

Patient Experience

Healthcare (Basel, Switzerland)2026

Cyberspace Supplementary Health Services and Patient Loyalty: The Role of Patient Experience in Saudi Arabia

Alaeddin Ahmad, Nizar Alsubahi, Fahad Alhazmi, Amani Al-Refai, Sara Fuad Talafha, Mohannad Alkhateeb, Mahmoud Alfatafta

Background: Digital transformation has changed how patients interact with hospitals, making online supplementary services an important part of perceived service quality and relationship outcomes. This study examined the association between cyberspace supplementary health services (CSS), conceptualized as the Online Flower of Service (OFOS), and patient loyalty in private hospitals in Jeddah, Saudi Arabia, and evaluated whether patient experience mediates this relationship. Methods: A cross-sectional survey was conducted among adult inpatients and outpatients who had used at least one online hospital service. Data were collected electronically between 10 February 2026 and 10 May 2026 using a structured Arabic questionnaire administered via Google Forms. The final sample included 730 complete responses. CSS was measured across five digital supplementary dimensions (E-Information, E-Order Taking, E-Consultation, E-Billing, and E-Payment), alongside patient experience and patient loyalty, using five-point Likert scales. The measurement model was evaluated using confirmatory factor analysis, and the structural relationships were tested using structural equation modeling. Results: CSS demonstrated a significant positive association with patient loyalty (β = 0.282, p p p Conclusions: Digitally delivered CSS components were positively associated with patient loyalty, with patient experience serving as an important mediating mechanism. Strengthening online information access, appointment-related processes, digital consultation, billing transparency, and payment convenience may be associated with more favorable patient experiences and stronger loyalty intentions in private hospital settings in Saudi Arabia.

Why This Matters:Provides empirical clinical evidence from Healthcare (Basel, Switzerland) regarding Patient Experience outcomes.

Patient Experience

Rand health quarterly2026

Developing Patient-Reported Outcome Measures of Timely Experience of Diagnosis (PROMOTE-Dx) for Cancer: Survey and Quality Measure Development Report

Rebecca Anhang Price, Carl T Berdahl, Melissa A Bradley, Elizabeth Marsolais, Joshua M Pevnick, Danielle Schlang, Anagha Alka Tolpadi, Feifei Ye, Claire E O'Hanlon

This study documents the creation, testing, and performance of survey-based patient-reported measures for timeliness of cancer diagnosis, the Patient-Reported Outcome Measures of Timely Experience of Diagnosis (PROMOTE-Dx) for Cancer and the survey instrument used to derive these measures. PROMOTE-Dx can be used by health care organizations and health plans seeking to assess and improve timely diagnosis of cancer.

Why This Matters:Provides empirical clinical evidence from Rand health quarterly regarding Patient Experience outcomes.

Patient Experience

Emergency medicine journal : EMJ2026

Person-centred emergency care: translation and cross-cultural validation of the Australian Emergency Department Patient-Reported Experience Measure (ED PREM) in the Netherlands

Renée A M Tuinte, Claudia Bull, Job M Hoonhorst, Reinier P Akkermans, Marie Louise Moors, Jaap Ten Oever, Marlies Ejl Hulscher, Jacobien J Hoogerwerf

BACKGROUND: Measuring and evaluating patient experience in the emergency department (ED) is essential for improving the quality of emergency care. However, specific and validated tools to measure patient experience in the ED are lacking in many countries. The aim of this study was therefore to translate and cross-culturally validate the Australian ED Patient-Reported Experience Measure (ED PREM) for the Dutch setting. METHODS: A single-centre validation study was conducted in a Dutch academic hospital. Step 1 involved forward and backward translation to produce a Dutch translation of the ED PREM (prototype). Step 2 involved establishing face and content validity of the Dutch prototype through cognitive patient interviews and researcher team consensus meetings. Step 3 involved administering the resultant Dutch pilot ED PREM to an ED population (n=527), to be able to perform psychometric analyses on this sample. Descriptive statistics and item reduction analyses were conducted prior to confirmatory factor analysis (CFA). CFA was used to confirm the structural validity of the Dutch ED PREM, and internal consistency was assessed. RESULTS: The face and content validity of the prototype Dutch ED PREM was 'good' after 15 cognitive interviews and expert consultation. Over two-thirds of participants (357/527) completed the Dutch pilot ED PREM. Scores were high across all four domains. Several items were removed due to high ceiling effects and a large number of 'not applicable' responses. The final 18-item Dutch ED PREM showed acceptable model fit with CFA (χ2(df) 7519.55 (153), p<0.001, Root Mean Square Error of Approximation=0.090, Tucker-Lewis Index=0.942, Comparative Fit Index=0.951, Standardised Root Mean Square Residual=0.035). Internal consistency was high (Cronbach's alpha ranged 0.85-0.97 per domain). CONCLUSIONS: The final 18-item Dutch ED PREM showed good validity and reliability for measuring ED patient experience. It is suitable and feasible for use in clinical practice to assess and improve the person-centredness of emergency care.

Why This Matters:Provides empirical clinical evidence from Emergency medicine journal : EMJ regarding Patient Experience outcomes.

Patient Experience

Reproductive health2026

Development of patient-reported experience and patient-reported outcome measurement tool for abortion care in Ethiopia: a mixed-method study

Negash Wakgari, Stuart J Watson, Gizachew A Tessema, Delayehu Bekele, Zoe Bradfield

Systematic Review

BACKGROUND: Measuring patient-reported experiences and outcomes of abortion care would enhance access to person-centred and rights-based abortion care. Assessment requires a reliable measurement approach to improve healthcare outcomes and service quality. Worldwide, there are no patient-reported measures to assess abortion care experiences and outcomes from the perspectives of the women accessing this service. This study developed a Patient-Reported Experience Measure (PREM) and Patient-Reported Outcome Measure (PROM) tool for women receiving abortion care services in Ethiopia. METHODS: A sequential, exploratory mixed-methods study was conducted to develop the measures through standard tool development approaches. First, item pools were identified via a systematic review exploring experiences and current measures of outcomes of abortion care in sub-Saharan countries, and a qualitative study exploring the lived experience of abortion care pathways in Ethiopia. Second, item pools for experiences and outcomes of abortion care were assessed by a panel of experts in Ethiopia during two modified Delphi rounds. Items were removed if expert consensus or the item-level content validity index (I-CVI) was not achieved (I-CVI < 0.70). Finally, cognitive interviews were conducted with women to assess the relevance of measurement, interpretation, judgment formation, information recall, and response mapping. Qualitative data were analysed using inductive thematic analysis. Quantitative data were analysed descriptively using frequencies and percentages. RESULTS: Overall, 72 items were included in the first round of the modified Delphi study, while 30 items remained in the final tools. Twenty-one items for the PREM and nine items for the PROM were retained. During the second Delphi round, I-CVI ranged between 0.55 and 1. During cognitive interviews, women reported that item instructions, wording, response options, and the recall period were clear and comprehensible. Women also described that the developed tool was relevant, brief, and covered important experiences and outcomes of abortion care. CONCLUSIONS: The PREM and PROM tool was developed to assess experiences and outcomes for Ethiopians who access abortion care services. Researchers and healthcare providers can use the new measurements to monitor service quality, and policymakers can use the tool's results to improve women's health. Future research should undertake psychometric validation and assess potential applications worldwide.

Why This Matters:Provides empirical clinical evidence from Reproductive health regarding Patient Experience outcomes.

Patient Experience

BMJ paediatrics open2026

Using cognitive interviews with children to test the content validity of a paediatric patient reported experience measure

Karlen R Barr, Erika Fortunati, Zachary Studniberg, Jessica Nikolovski, Leslie White, Sarah Elliott, Lynn McCartney, Dianna Smith-McCue, Mary Noah, Girish Swaminathan, James R John, Claire Treadgold, Aaron Hall, Ann Dadich, Barb Vernon, Elesha Toscano, Harriet Hiscock, Josephine Chow, Leanne Johnston, Lisa Whitehead, Mandie Foster, Valerie Sung, Valsamma Eapen

BACKGROUND: Paediatric patient reported experience measures (pPREMs) can help children's voices be heard to evaluate and improve healthcare delivery. However, no standardised child-completed pPREM has been co-designed with children and validated in Australia. This research aimed to test the content validity of a co-created pPREM using an iterative, participatory approach with children. METHODS: 21 children aged 6-11 years were recruited across four Australian hospitals. Children participated in online cognitive interviews to evaluate pPREM items and rating scales (using 'stars' or 'smiley faces') for their understandability, usability, relevance and importance related to their needs in hospital. Framework analysis was conducted iteratively, with items refined after the first round of interviews based on children's feedback. RESULTS: Most (n=20; 95%) children understood the instructions. After nine interviews, two items were revised: 'Someone I knew could stay with me' changed to 'Family and friends could be with me' and 'I was able to talk to other patients', to 'I was able to talk to other kids in hospital'. Following these revisions, all children understood most (13 of 18=72%) items. In the remaining five items, some phrases, such as 'Care and treatment', were not easily understood, and items were edited according to children's feedback. Most children (n=14; 67%) preferred the 'smiley faces' rating system, and 83% (n=15) reported the number of questions as the right amount. Children generally found all items important, although some items did not apply to all and a 'Does not apply to me' response option was added. CONCLUSIONS: Children aged 6-11 years can meaningfully engage with a co-designed pPREM. Cognitive interviews and an iterative approach helped identify and rectify comprehension issues. It is feasible to involve children in the design of pPREMs and doing so strengthens pPREMs' usability and understandability.

Why This Matters:Provides empirical clinical evidence from BMJ paediatrics open regarding Financial Performance outcomes.

Financial Performance

Health expectations : an international journal of public participation in health care and health policy2026

Validation of a Patient-Created, Patient-Reported Experience Measure for Inflammatory Bowel Disease in the United Kingdom

Zoe Guy, Daniel Hind, Nikki Totton, Elena Sheldon, Naseeb Ezaydi, Matt Bursnall, Alan Lobo

INTRODUCTION: Inflammatory bowel disease (IBD) significantly impacts quality of life and has high healthcare contact. Ensuring that patients are experiencing the best care is therefore essential and has been the focus of many quality improvement initiatives. To support this, in collaboration with patients, we developed a patient-reported experience measure for IBD (IBD-PREM) for use in a UK context. This article refers to the validation of this patient-developed measure to ensure it is valid and reliable. METHODS: Using data from the AWARE-IBD study, 287 participants provided data between November 2021 and November 2024. The IBD-PREM as well as the IBD-Control questionnaire was collected at 3-month intervals as well as 2 weeks post baseline. Validation was completed through testing the following aspects: acceptability (response rate and missing data rates), reliability (internal consistency and test-retest reliability), validity (construct and structural validity using factor analysis) and responsiveness (ceiling/floor effects and smallest detectable difference). RESULTS: High response rates and low missing data demonstrated acceptability of the IBD-PREM. There was also good test-retest reliability (ICC = 0.88). Low ceiling and floor effects demonstrate suitable responsiveness as did the ability to differentiate between patients with active and inactive disease (effect size = 0.62). The confirmatory factor analysis suggested the current domain structure (three domains) is not optimum and factor loadings indicated some potentially redundant items, which is supported by the high internal consistency (α = 0.97). CONCLUSIONS: The patient-developed IBD-PREM is a tool that can be used as a method for assessing the healthcare experiences of IBD patients in the United Kingdom. Superior psychometric properties were found compared to measures developed through traditional researcher-led approaches suggesting the benefit of involving patients early in the methodological process. Further refinement in terms of item reduction and domain restructure should be implemented to optimise the PREM as well as external validity to other contexts. PATIENT OR PUBLIC CONTRIBUTION: Patients and members of the public were engaged from an early stage in the development of the PREM, contributing directly to the design and content of the IBD-PREM. This article goes on to validate this patient-created measure with input from a patient representative.

Why This Matters:Provides empirical clinical evidence from Health expectations : an international journal of public participation in health care and health policy regarding Patient Experience outcomes.

Patient Experience

Value in Health2026

Barriers and facilitators to implementing patient-reported outcome and experience measures (PROMs/PREMs) in health systems: a comprehensive overview of systematic reviews

Guillaume Fontaine, Meagan Mooney, Joshua Ramos, Laura Crump, Marie-Eve Perron, Marie-Eve Poitras, Maxime Sasseville, Rachael Laritz, Lydia Ould Brahim;, Sylvie D. Lambert, Sydney Wasserman, Marie-Pascale Pomey, Frédéric Bergeron

Systematic Review

OBJECTIVES: Patient-reported outcome measures and experience measures (PROMs/PREMs) are central to person-centred, value-based healthcare. We synthesized barriers and facilitators influencing the implementation of PROMs and PREMs to identify priorities for health system action and research. METHODS: We conducted an overview of systematic reviews adhering to JBI and PRIOR guidelines. Databases were searched in June 2023, with hand-searching to March 2026. Two reviewers performed screening, quality appraisal, and factor coding using the Consolidated Framework for Implementation Research (CFIR). Data synthesis included thematic analysis by CFIR construct. RESULTS: Thirty-two reviews contributed 1,326 factor mentions across 44 of 48 CFIR constructs and spanned diverse clinical populations and settings. The five most salient barriers (40.2% of mentions) were patients' difficulty completing measures because of literacy, language, illness, disability, or limited digital access; poor integration into clinical workflows and information systems; lengthy, inaccessible, or difficult-to-use measures and platforms; complex administration, interpretation, and response processes; and clinicians' limited motivation to collect or use results. The five leading facilitators (34.7% of mentions) were user-centred measure and platform design; visible clinical benefits over usual care; reliable and interoperable IT infrastructure; workflows embedding completion, timely review, and follow-up; and patients' belief that measures addressed meaningful needs and improved communication. Evidence was concentrated in oncology and high-income settings, with limited PREM-specific coverage. CONCLUSIONS: PROM and PREM programmes should prioritize workflow and IT integration, inclusive design of measures and platforms, clear ownership, and support for patients and clinicians. This review can guide implementation investment, local pre-implementation work, and evaluations.

Why This Matters:Provides empirical clinical evidence from Value in Health regarding Healthcare Quality outcomes.

Healthcare Quality

The International journal of pharmacy practice2026

Developing items for a patient-reported experience measure for post-discharge medicines management in older patients: a stakeholder-led approach

Justine Tomlinson, Adam Nyende, Nazreen Butt, Boris Burnell-Anderson, Beth Fylan, Heather Smith, Jonathan Silcock, Rebecca Lawton

OBJECTIVES: Medication-related harm following hospital discharge is a well-documented patient safety concern, particularly among older adults with multiple health conditions. Despite increasing attention to transitions of care, there is no patient-reported experience measure (PREM) specifically focused on post-discharge medicines management. Existing tools primarily measure clinical outcomes, overlooking how patients experience and manage medicines during this vulnerable period. The overarching aim was to develop PREM items for post-discharge medicines management in older adults using a stakeholder-led approach. This paper outlines the methods used to generate, refine, and pilot the PREM items. METHODS: We developed PREM items by drawing on existing literature and working with patient and public involvement (PPI). We organised four iterative co-design workshops involving patients, carers, and healthcare professionals, and we generated, refined, and prioritised items. Items were grouped into domains and revised based on feedback. Readability was assessed and further refined through piloting. KEY FINDINGS: The initial pool of 147 items was reduced to an 18-item PREM tool for use two weeks post-discharge and a 15-item PREM tool for three months post-discharge. Items cover five domains: information, involvement, relationships, systems, and autonomy. Piloting indicated good readability and acceptability, with feedback highlighting the importance of clear language and logical question sequencing. Notable differences emerged between patient and healthcare professional perspectives on care and communication priorities, which we reconciled through a collaborative approach. CONCLUSION: This work presents PREM items developed through stakeholder-led methods, focused on capturing patient experience in post-discharge medicines management, offering a potential mechanism for assessing care quality. Further validation in diverse populations is underway to support safer, person-centred medicines management.

Why This Matters:Provides empirical clinical evidence from The International journal of pharmacy practice regarding Patient Experience outcomes.

Patient Experience

Healthcare (Basel, Switzerland)2026

Characteristics of Patient Complaints in a Large Tertiary Hospital in China: A Longitudinal Analysis from 2022 to 2024

Baoxiang Wang, Xuyuan Kuang

BACKGROUND: Patient complaints provide critical insights into healthcare quality and patient experience, serving as a direct feedback mechanism for service improvement. OBJECTIVE: This study aimed to characterize major complaint categories, departmental distribution, personnel attribution, and resolution effectiveness of patient complaints at a large Chinese tertiary hospital using empirical data from 2022 to 2024. METHODS: A retrospective observational design was conducted on complaint records (2022: n = 187; 2023: n = 192; 2024: n = 201) at Xiangya Hospital. All data presented are empirically observed records from the hospital's internal complaint management system; no hypothetical projections or modelled data are included. Complaints were independently categorized into six themes by two researchers (Cohen's κ = 0.84). Resolution effectiveness was coded by the hospital's complaints office. Descriptive statistics and chi-square tests were performed using R software. A complementary SWOT analysis was conducted to assess institutional complaint management capacity. RESULTS: Service attitude (25.1% in 2022, 23.4% in 2023, 21.9% in 2024) and communication (20.3%, 18.8%, 17.2%) constituted the largest complaint categories, both showing significant declining trends (χ2_trend = 6.54, df = 2, p = 0.038 for communication; χ2_trend = 5.98, df = 2, p = 0.045 for service attitude). The top three departments with the highest complaint volumes were General Surgery (16.6% in 2022), Gastroenterology (12.8%), and Otolaryngology (9.6%). Seasonal analysis revealed that the third quarter (July-September) was the peak complaint period (29.4% in 2022). The overall effective resolution rate improved from 62.3% in 2022 to 67.7% in 2023 and 71.5% in 2024 (χ2_trend = 8.12, df = 2, p = 0.017). Treatment outcome complaints showed a relative increase from 18.2% in 2022 to 20.1% in 2024, while billing/administrative complaints increased from 15.0% to 17.4%. CONCLUSION: Systematic analysis of patient complaints effectively identifies recurrent issues and informs quality improvement strategies. A balanced focus on both "soft skills" (e.g., communication, empathy) and "hard system" factors (e.g., processes, resources) is essential. Continuous monitoring and responsive feedback mechanisms are crucial for sustaining improvements in patient safety and satisfaction.

Why This Matters:Provides empirical clinical evidence from Healthcare (Basel, Switzerland) regarding Patient Experience outcomes.

Patient Experience

BMC primary care2026

Psychometric properties and constructs of Patient Reported Experience Measures (PREMs) in primary care: a scoping review

Véronique Lowry, Marie-Ève Perron, Pierre-Henri Roux-Levy, Cloé Beaulieu, Vanessa T Vaillancourt, Maxime Sasseville, Marie-Eve Poitras

BACKGROUND: Positive patient experience is associated with improved health outcomes and greater adherence to recommended care. Patient-reported experience measures (PREMs) are tools developed to assess these experiences and can be used for multiple purposes, including to inform quality improvement. Patient experience is a complex concept that lacks a standardized definition, with multiple constructs described in the literature. The variety of available PREMs makes it difficult for knowledge users to select those that are valid, reliable, and suitable for their specific practice settings, particularly in primary care. The objective of this scoping review is to identify and describe PREMs developed for the primary care context, the constructs measured and their psychometric properties. METHODS: Following the JBI methodology and PRISMA-ScR guidelines, we conducted a scoping review of studies presenting the development or the psychometric properties of PREMs for adults in primary care in an original or a synthesis design. We searched databases (MEDLINE, CINAHL, Scopus) for studies between January 2019 and December 2023. Two independent reviewers screened and selected studies. They extracted PREMs constructs, psychometric properties, number of items, time of completion and tool availability. RESULTS: Seven studies, including three synthesis designs, were included in the review. From these papers, 23 PREMs were included for data extraction. Tools focusing exclusively on a single component of patient experience, a specific population, or a narrowly defined context were excluded. The constructs most frequently represented across identified tools included accessibility, relational aspects, and quality of clinical care or services. However, no tool covered all relevant constructs, highlighting the variability in defining patient experience. Tools ranged from 4 to 74 items, with limited reporting on completion time. Only five tools involved patients in their development, potentially limiting their applicability in routine practice. Psychometric properties varied, with most tools demonstrating acceptable validity and reliability. However, inconsistencies in reporting and testing methods were noted. CONCLUSION: This review highlights the diversity of PREMs validated for primary care and the variability in their constructs and psychometric properties. Improving conceptual clarity and alignment of patient experience constructs across PREMs, while ensuring meaningful patient involvement in tool development, and rigorous psychometric testing are essential to enhance their utility. This study supports the integration of PREMs into primary care quality improvement initiatives, contributing to more patient-centered healthcare delivery.

Why This Matters:Provides empirical clinical evidence from BMC primary care regarding Patient Experience outcomes.

Patient Experience

Journal of patient-reported outcomes2026

Implementation strategies for embedding patient-reported outcome and experience measures (PROMs/PREMs) in routine care: secondary analysis of an umbrella review

Guillaume Fontaine, Joshua Ramos, Meagan Mooney, Marie-Eve Perron, Laura Crump, Sylvie D Lambert

Systematic Review

BACKGROUND: Routine capture of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) is championed as core infrastructure for learning health systems and value-based care. Yet, the guidance on how to implement these measures is scattered. We synthesised evidence on implementation strategies used to introduce and sustain PROMs and PREMs, and examined how these strategies align with common barriers and stages of implementation. METHODS: We conducted a secondary analysis of an umbrella review (25 reviews; 1086 primary studies, 2014–2023) that catalogued implementation determinants and processes of PROMs and PREMs. Two reviewers independently coded implementation strategies using the 73-item Expert Recommendations for Implementing Change (ERIC) taxonomy. Strategies were temporally mapped to the phases of the Exploration–Preparation–Implementation–Sustainment (EPIS) framework, and onto the barriers identified in the parent review using the CFIR × ERIC matching tool. RESULTS: Twenty of 25 reviews reported at least one implementation strategy, yielding 152 instances coded to 43 of 73 ERIC strategies. Pre-implementation strategies (74 instances) focused on local consensus building, readiness and barrier assessments, early IT integration, and front-loaded education and champion preparation. During implementation and sustainment (78 instances), the strategies most often used were audit and feedback, real-time data feedback to clinicians, reminders, facilitation, technical assistance, refresher training, and patient onboarding and prompts. Mapping strategies to key barriers showed reasonable coverage for workflow, staff capability, and organisational fit, but gaps for patient capability, long-term financing, data analytics, and equity. Thirty ERIC strategies were not identified, most relating to policy, financing, or market-shaping. CONCLUSION: Implementing PROMs and PREMs in routine care requires coordinated changes in relationships, workflows, technology, and incentives. This study organises existing evidence into practical tools that health system teams and researchers can use to select, sequence, and resource implementation strategies for PROM and PREM programmes.

Why This Matters:Provides empirical clinical evidence from Journal of patient-reported outcomes regarding Patient Experience outcomes.

Patient Experience

BMC health services research2026

Patient-reported outcome and experience measures in primary care: a scoping review of systematic collection and use

Candan Kendir, Angel Gonzalez de la Fuente, Dionne Kringos, Michael van den Berg, Jose Maria Valderas, Niek Klazinga

BACKGROUND: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognised as essential instruments for improving quality of care, accountability, and person-centredness. Primary care, as the entry point and coordinator of most patient journeys, is uniquely positioned to capture these insights systematically. Yet, while PROMs and PREMs are increasingly established in hospital and condition-specific contexts, evidence on their systematic implementation across primary care systems remains fragmented. This scoping review aimed to explore current programmes to the systematic collection and use of PROMs and PREMs in primary care, identifying common purposes, mechanisms, and enabling and challenging conditions across health system (macro) and organisational (meso) levels. METHODS: A scoping review was conducted following Arksey and O’Malley’s framework, refined by Levac et al. Peer-reviewed articles were searched across PubMed, Scopus, Web of Science, Embase, and complemented by grey literature search via Overton. Studies published in English or French between 2009 and 2024 were included. Data were charted to describe implementation scope, purpose, data collection mechanisms, and uses at different system levels. RESULTS: After screening 3,762 records and reviewing 211 full texts, 18 programmes met inclusion criteria. The initiatives identified revealed substantial diversity in purpose, maturity, and integration. Five programmes were primarily oriented to clinical care and quality improvement, while five national survey programmes embedded PREMs within performance monitoring and accountability frameworks. Reported enablers included clear governance structures and sustained funding (n = 6), interoperability with electronic health records or national data repositories (n = 8) and sustained professional and patient engagement (n = 4). PROMs most frequently addressed health-related quality of life/functioning and mental health domains (n = 7), whereas PREMs focused on access, communication, continuity and person-centredness (n = 8). Patient-reported data were used to support organisational learning cycles (n = 5), regional/national benchmarking and equity monitoring (n = 5), and system-level accountability (n = 3). CONCLUSION: Systematic use of PROMs and PREMs at the macro and meso levels in primary care remains uneven, with limited but growing examples of embedding in infrastructures that link patient-reported data to quality improvement and policy. Strengthening governance, digital integration, and capacity for interpretation and use is essential to realise their potential for accountability, equity, and person-centred primary care.

Why This Matters:Provides empirical clinical evidence from BMC health services research regarding Patient Satisfaction outcomes.

Patient Satisfaction

Oral surgery, oral medicine, oral pathology and oral radiology2026

Development of a patient-reported experience measure for temporomandibular disorders: exploratory factor analysis and reliability testing

Dina Taimeh, Richeal NiRiordain, Stefano Fedele, Rachel Leeson

139 patients

OBJECTIVES: This study evaluated the structural validity, internal consistency, and test-retest reliability of a newly developed patient-reported experience measure (PREM) for individuals with painful temporomandibular disorders. This PREM was developed to assess the experience of patients while receiving healthcare. STUDY DESIGN: This study had a cross-sectional design. A total of 139 patients completed the PREM following clinical visits, with 50 repeating it 2 weeks later. Exploratory factor analysis (EFA), Cronbach α coefficient, and interclass correlation coefficient were utilized to assess the structural validity, internal consistency, and test-retest reliability, respectively. RESULTS: EFA identified a 5-factor structure with 21 items. These domains were "emotional support," "respect for patient centred values," "information, communication and education," "access to care," and "coordination of care." The Cronbach α was 0.7285, indicating good internal consistency, and the intraclass correlation coefficient for the total score was 0.732, reflecting good test-retest reliability. CONCLUSIONS: The PREM is a brief tool, which shows potential in assessing patient experiences in facial pain services. It may also support audits and clinical research. Further psychometric validation is recommended.

Why This Matters:Provides empirical clinical evidence from Oral surgery, oral medicine, oral pathology and oral radiology regarding Patient Experience outcomes.

Patient Experience

Revista espanola de enfermedades digestivas2026

Patient-related experience measurement scales for endoscopy procedures – A systematic review, COSMIN and Conceptual Model evaluation

Maria José Dias, Hugo Rodrigues, Mário Dinis-Ribeiro, Nuria Fabrellas, Cristina Esquinas López, María Paz Fernández-Ortega

Systematic Review

BACKGROUND: patient experience is a quality indicator in gastrointestinal endoscopy, as recognized by the European Society of Gastrointestinal Endoscopy (ESGE). Despite this, no standardized tools or metrics have been formally endorsed for routine use. OBJECTIVE: to identify and evaluate patient-reported experience measures (PREM) used in endoscopic procedures, assessing their psychometric properties and conceptual completeness, and to explore gaps for future development. METHODS: a systematic literature review was conducted up to March 2023, including studies involving adults (> 18 years) who underwent endoscopic procedures and completed PREM. Instruments were assessed using the COSMIN risk of bias tool and a patient experience conceptual model. RESULTS: of 1.911 articles screened, 10 studies met the inclusion criteria. The Colonoscopy Experience Score Tool (CEST) proved the strongest psychometric performance, while the Endoscopic Patient-Reported Experience Measure (ENDOPREM) showed superior conceptual coverage. However, no single instrument met both psychometric and conceptual standards. A critical gap identified across all tools was the absence of items related to patient health motivation. CONCLUSION: CEST is psychometrically superior and ENDOPREM is conceptually robust. Future PREM should adopt a hybrid approach-combining the psychometric strengths of CEST with the conceptual complexity of ENDOPREM-while also incorporating domains such as patient motivation to improve relevance and impact. IMPLICATIONS: measuring patient experience requires tools that are currently both scientifically rigorous and patient-centered. Developing a Hybrid PREM is an essential next step to support quality improvement in endoscopic care.

Why This Matters:Provides empirical clinical evidence from Revista espanola de enfermedades digestivas regarding Patient Experience outcomes.

Patient Experience

Frontiers in health services2025

Impact of hospital complaint handling on promoting high-quality development of hospitals via an emotional language analysis model: a case study of a tertiary hospital service center in Quanzhou city, Fujian province

Caijiao Zheng, Yi Zhang, Xiaolong Lian, Jinxiu Ke, Hongxia Chen, Yiwen Chen

BACKGROUND: In the healthcare service industry, patient complaints serve not only as a critical metric for assessing hospital service quality but also as a fundamental driver of high-quality hospital development. Through a systematic analysis of patients' perceptions, opinions, and emotional responses to hospital management within the complaint-handling process. METHODS: Therefore, this paper aims to develop a hospital complaint-handling analysis model to enhance public satisfaction with greater precision. First, complaint data from hospitals spanning January to December 2022-2024 was preprocessed using data cleaning, mechanical compression, word segmentation, and stop-word filtering techniques. Second, the DISC behavioral language model was employed to analyze key indicators, including hospital compensation frequency, total compensation amounts, patient appeal rates, complainants' satisfaction with the resolution process, and their overall satisfaction with complaint outcomes. Finally, a sentiment analysis model and an improved KANN-DBSCAN clustering model were applied to complaint data to precisely identify sentiment-related keywords and assess the intensity of negative emotions, providing hospitals with targeted improvement recommendations. RESULTS: This study applied the DISC behavioral model to medical complaints. DISC-based text analysis enabled tailored responses. Among 334 intervention and 341 control cases, satisfaction 93.39%, was higher in the intervention group 83.24%, indicating improved complaint resolution through behavior-informed communication strategies. CONCLUSIONS: By analyzing patients' psychological needs and expectations, this study aims to minimize financial compensation and reduce patient appeals while enhancing overall complaint resolution satisfaction, which provides medical institutions with a more comprehensive, effective, and personalized complaint-handling strategy while simultaneously improving patients' healthcare experiences.

Why This Matters:Provides empirical clinical evidence from Frontiers in health services regarding Patient Experience outcomes.

Patient Experience

Patient preference and adherence2025

Antecedents of Patient Loyalty: Exploring Mediating and Moderating Paradigms in Public Hospitals

Abid Hussain, Shahida Kanwel, Sania Khan, Wadi B Alonazi, Azam Malik, Ali Ahmed Khan

PURPOSE: Countries around the world acknowledge the vital role of effective healthcare services in fostering economic, social, and human development. Consequently, many are striving to enhance their medical facilities. This study specifically examines public hospitals in Pakistan and aims to create a framework for evaluating patient loyalty. METHODS: Responses from 650 patients were collected using a random sampling technique. The gathered data were analyzed using the Statistical Program for Social Sciences (SPSS) and Analysis of Moment Structures (AMOS). RESULTS: The analysis revealed significant relationships among administrative procedures, service effectiveness, patient satisfaction, and loyalty. Additionally, the study identified patient satisfaction and administrative procedures as mediators between service effectiveness and patient loyalty. It also investigated the moderating roles of participative leadership and brand image in shaping administrative procedures, patient satisfaction, and patient loyalty. CONCLUSION: These findings offer valuable insights for healthcare authorities in formulating strategies to improve service delivery in public hospitals. Addressing existing deficiencies and enhancing healthcare systems is essential to fostering patient loyalty in these environments.

Why This Matters:Provides empirical clinical evidence from Patient preference and adherence regarding Patient Satisfaction outcomes.

Patient Satisfaction

Health communication2025

Examining the Roles of Communication and Trust in Patient-Provider Relationships and Their Association with Patient Satisfaction with Care

Samee A Hameed, Anna Klyueva, Isabelle S Kusters, Julianna M Dean

Patient-provider relationships can significantly influence patients' perceptions of quality of care and generally affect patient trust in healthcare providers. The purpose of this study was to investigate how communication based on CAT strategies can enhance the patient-provider relationship, ultimately improving patients' perceptions of the quality of care they receive. Additionally, we examined the relationship between patients' trust in the cancer- and health-related information provided by their doctors and their satisfaction with the quality of care. Data from the 2022 health Information National Trends Survey (HINTS 6, n = 6252 surveys) was used. Results demonstrate that the use of CAT strategies that encompass three domains - emotional expression, interpersonal control, and interpretability - play a larger role in patient satisfaction with quality of care than trust in health-related information from their doctor alone. To improve satisfaction with care, these findings show possible targetable domains of patient-provider relationship building in healthcare.

Why This Matters:Provides empirical clinical evidence from Health communication regarding Patient Satisfaction outcomes.

Patient Satisfaction

Scientific reports2025

Service quality as a driver of perceived value satisfaction and revisit intention in Indonesia

Alvera Noviyani, Pramon Viwattanakulvanid

Recent literature on healthcare quality shows the important of patient-centred design, hence more contextualized and patient-perspective research is needed to assess service quality. Hence, this study aimed to analyse the relationship and explores the influence of service quality in national central public hospital and how they are perceived and impact outpatient satisfaction, perceived value, and revisit intention in Indonesia. This mixed-method study had a sample size of 770 outpatients for the quantitative phase and 12 outpatients for the qualitative phase from national central public hospital in Indonesia. The quantitative analyse the construct of service quality dimensions and incorporates them with the literature to develop a conceptual model that suits and represents a developing country. The qualitative phase explores the relationship between each construct in the conceptual model and provide the meaning and in-depth explanation of the model results. The five dimensions of service quality were tangibility, assurance, empathy, reliability, and responsiveness. These dimensions have a positive and significant impact on patient perceived value and satisfaction. The quantitative results confirm that patient satisfaction and patient perceived value significantly impact outpatient’s revisit intention and can significantly mediate the influence of service quality on revisit intention; however, patient perceived value does not significantly impact patient’s satisfaction. The qualitative results explain, service quality provided by the hospital influence patient perceived value of choosing the hospital, and perceived value does not considerably impact patient satisfaction. In addition, although waiting time has been widely studied globally, empirical evidence on its influence within the Indonesian healthcare context remains limited. In this study, waiting time was found to have the most substantial impact on outpatient satisfaction and revisit intention. While the healthcare providers and the government in Indonesia can increase patient perceived value by improving the service quality factors. Practitioners should invest in building trust and communication to reach out to their patients and increase patient loyalty.

Why This Matters:Provides empirical clinical evidence from Scientific reports regarding Patient Satisfaction outcomes.

Patient Satisfaction

The Journal of hand surgery2025

Building a Positive Online Reputation in Hand Surgery: Quantitative Analysis of Factors Linked to Patient Five-Star Reviews

Evan H Richman, Dylan R Rakowski, Benjamin R Paul, Brian W Paul, Daniel Stokes, Alexander Lauder

PURPOSE: Online physician review websites have changed the health care landscape by offering patients accessible platforms to evaluate and share their experiences. Physician review websites, such as Google Reviews, Yelp, and Healthgrades, may influence patient preferences and health care delivery. This study aimed to identify both clinical and nonclinical factors associated with five-star reviews to provide actionable insights for surgeons to improve patient experience and satisfaction. METHODS: Fifty fellowship-trained hand surgeons practicing in 10 major metropolitan areas were randomly selected from the American Society for Surgery of the Hand directory. Reviews from Google.com rated five stars were analyzed, with a maximum of 20 reviews per surgeon. Compliments were categorized as clinical (eg, treatment plans, diagnoses, outcomes, and pain management) or nonclinical (eg, physician/staff professionalism, wait times, scheduling, and cost) and classified as surgical or nonsurgical. Two independent reviewers analyzed the reviews, with discrepancies resolved by a third reviewer. Univariate analysis and chi-square tests were used to assess categorical variables. RESULTS: A total of 448 five-star reviews containing 691 compliments were analyzed. Clinical compliments constituted 43.8%, whereas 56.2% were nonclinical. Common clinical compliments included clear treatment plans (21.1%) and good outcomes (19.7%). Nonclinical compliments frequently highlighted physician professionalism (51.4%) and staff professionalism (23.2%). Surgical patients were more likely to mention good outcomes (44.0% vs 5.9%) and pain control (10.4% vs 1.4%), whereas nonsurgical patients emphasized physician professionalism (55.3% vs 44.4%) and staff professionalism (26.8% vs 16.8%). Private practice surgeons received more five-star reviews than academic surgeons, although average overall ratings were similar. CONCLUSIONS: Physician interpersonal skills and staff professionalism play critical roles in positive online reviews. Clinical outcomes are key drivers for surgical patients, whereas nonsurgical patients prioritize communication and alternative care options. CLINICAL RELEVANCE: This study identifies key factors associated with five-star reviews in hand surgery, offering actionable insights to enhance patient satisfaction.

Why This Matters:Provides empirical clinical evidence from The Journal of hand surgery regarding Patient Experience outcomes.

Patient Experience

Journal of patient experience2025

A Retrospective Analysis of Patient Feedback in a Major Regional General Hospital: Trends and Insights into Healthcare Experience

Xia Tian, Xiu Chen, Wenguang Fu

This study analyzed 1221 patient feedback cases, comprising both complaints and consultations, received via a national public service platform at a major Chinese regional general hospital. While the total volume of feedback increased, the proportion of formal complaints declined as consultations rose, suggesting a shift toward proactive information-seeking behavior. Consultations most frequently involved hospital procedures and medical expenses, highlighting patients' growing need for guidance and system navigation support. Most complaints were related to hospital management, medical quality, and communication, with surgical departments and physicians most frequently cited. Seasonal peaks occurred in the third quarter. These findings offer valuable insights into evolving patient expectations and support targeted improvements in hospital communication, staffing, and feedback management systems.

Why This Matters:Provides empirical clinical evidence from Journal of patient experience regarding Patient Experience outcomes.

Patient Experience

International journal of medical informatics2025

One Size Fits None. How can we do better? using patient reported experience measure findings to drive local quality improvement across wards in a large Australian metropolitan hospital

Teyl Engstrom, Christine Petrie, William Pinzon Perez, Clair Sullivan, Jason D Pole

Qualitative Study

INTRODUCTION: Patient reported experience measures (PREMs) are being collected across entire jurisdictions, resulting in large volumes of rich qualitative patient feedback. However, this collection of data is often not connecting with local quality improvement efforts. This study aims to answer the question: "Are there meaningful differences in the patient experience of care, as measured through qualitative survey feedback, among wards at a large metropolitan hospital?" to assess the need to analyse PREMs data at a ward level to identify actionable insights. METHODS: We utilise 6-months of PREMs surveys from a jurisdictional level survey in a large metropolitan hospital in Australia, focusing on Gynaecology, Maternity, Surgical and Short Stay wards. Responses to two qualitative questions concerning (i) what was good about their care, and (ii) what could be improved about their care were analysed using a semi-automated machine learning based content analysis tool, Leximancer. We performed a quantitative comparison between the hospital wards of the concepts identified from the text and their frequencies, estimated with the Cramer's V, and a qualitative comparison between wards of the three most prevalent concepts and the details reported by patients. RESULTS: In the quantitative comparison, we found a moderate association of the concepts reported between the wards (Cramer's V: 0.36-0.67). The qualitative analysis showed that even when the high-level issue being reported was shared across wards, the nuances often differed, especially for feedback related to improvements in care. CONCLUSION: Our study found there were substantial differences between the issues and details reported by patients across different wards, highlighting the importance of analysing PREMs at a ward level to inform quality improvement. We demonstrated a standardised way to analyse this data at ward level by employing semi-automated content analysis. These findings provide a clear method that health services can use to analyse PREMs data to drive on-the-ground quality improvement for patients.

Why This Matters:Provides empirical clinical evidence from International journal of medical informatics regarding Patient Experience outcomes.

Patient Experience

The International journal of health planning and management2025

Implementation of Automated PREM Process to Better Capture Patients' Overall Experience of Care Services at Karolinska University Hospital

Alexandre Chakhunashvili, Anna Blommengren, Anna Kullberg

To improve healthcare quality there has been a growing interest in collecting and analysing patient feedback. Patient Reported Experience Measures (PREMs) are instruments through which the feedback can be collected and used for improvement purposes. However, the collection process is often associated with an administrative burden for healthcare professionals who collect and register surveys manually. Additionally, the manual procedure limits the data collection efforts to fewer patients, thus resulting in a less representative sample. A digital and automated procedure for collecting and visualising patient experience data can relieve healthcare staff and allow more patients to share their experiences. At Karolinska University Hospital, a multi-disciplinary project to develop the automated PREM process-from data collection to visualisation-has been undertaken. As a result, there are about 25,000 digital questionnaires distributed per month with the response rate of approximately 35%-40%. This is an equivalent of about 9000 completed questionnaires per month to be compared to less than 1000 responses per month received during the manual process used before 2021. The large amount of patient experience data is analysed and made accessible to the hospital management and staff. To increase the transparency, part of the collected data is visualised at Karolinska's external website. Furthermore, hospital staff is relieved from all survey administration. Remaining challenges concern survey language and the analysis of textual responses that are not yet done at hospital level. Overall, this initiative has led to several quality improvement activities and contributed to strengthening Karolinska's internal learning health system.

Why This Matters:Provides empirical clinical evidence from The International journal of health planning and management regarding Patient Experience outcomes.

Patient Experience

The International journal of health planning and management2024

Using patient feedback to predict effects of quality improvement initiatives

Sirou Han, Zhanming Liang

BACKGROUND: Internationally, continuous efforts have been put into developing patient complaint channels to understand patients' experience and expectation of care, which can guide the improvement of health service quality. Despite agreement among the value of patient feedback, limited attention has been paid to using patient feedback to predict and promote the actual quality improvement initiatives. OBJECTIVE: To determine whether patient feedback collected from a public feedback hotline can be used to predict the effect of hospital quality service improvement initiatives. METHODS: A retrospective analysis of patient complaint data of a tertiary hospital from 2018 to 2021 was performed. Patient complaints were first coded by the standard classification method of the Australian Hospital Patient Experience Question Set. The characteristics of patients' complaints were then analysed by frequency and contingency table analysis. Finally, through Nonparametric Mann-Kendall test and Joinpoint regression model, the trends of each complaint characteristics were tested. RESULTS: Amongst the 771 complaints received against clinicians, approximately 75% of them were concerning doctors. 'Harm and distress' was the key reason of complaints, followed by 'not cared for', 'lack of confidence', 'needs unmet' and 'not informed'. In 2021, the number of complaints received in relation to moderate 'harm and distress' caused by doctors increased by 667% from 2020. The categories of 'not informed', 'not cared for' and 'harm and distress' were also on the rise with statistical significance. In addition, complaints related to the lack of respect, bad attitude and unprofessional behaviour demonstrated by nurses (n = 83) and doctors (n = 121) were also recorded. CONCLUSION: Patient feedbacks collected via a public feedback hotline provides a useful platform to gain insight into patient experience of care which are valuable to guide quality care improvement. To improve the care quality, clinicians need to participate in quality improvement strategies development at an early stage. Efforts in improving communication and interaction between doctors and patients are needed to improve patients' experience of care and developing patients' trust in both of the clinicians and the medical services. The study highlights the value of using public feedback hotline to generate evidence that can guide hospital service improvement.

Why This Matters:Provides empirical clinical evidence from The International journal of health planning and management regarding Patient Experience outcomes.

Patient Experience

Journal of Healthcare Management2017

Patient Experience and Hospital Financial Performance: Examining the Link Between Quality and Margins

Richter JP, Muhlestein DB

Longitudinal Empirical Panel3,000+ Acute Care Hospitals

This empirical investigation examines the relationship between patient experience performance metrics (HCAHPS) and hospital financial viability across a multi-year national panel. Results demonstrate that healthcare providers achieving top-quartile patient experience ratings earn significantly higher operating profit margins and Return on Assets (ROA) compared to competitors, driven by patient retention, referral volume, and minimized litigation risk.

Why This Matters:Establishes a rigorous financial business case for clinical patient experience. High patient satisfaction directly protects clinic margins and accelerates sustainable organic growth through referrals.

Financial Performance

BMJ Quality & Safety2016

Online Physician Reviews and Patient Sentiment: Association With Clinical Quality and Satisfaction Surveys

Ranard BL, Werner RM, Patel T, et al.

Cross-Sectional Observational Study16,824 Patient Reviews

Background: Online patient reviews are frequently questioned by practitioners regarding whether they reflect clinical quality or merely hotel-like amenities. Methods: Natural language processing and sentiment analysis of thousands of verified reviews were compared directly against standardized clinical survey data. Findings: Online reviews strongly correlated with objective clinical metrics, especially physician communication, staff responsiveness, and patient recommendation intent.

Why This Matters:Proves that online reviews and Google ratings are an accurate reflection of clinical care quality and patient trust, reinforcing the need for automated proactive feedback collection before negative reviews reach public directories.

Reputation & Reviews

BMJ Open2013

A Systematic Review of the Evidence on Patient Experience and Clinical Safety and Effectiveness

Doyle C, Lennox L, Bell D

Systematic Review55 Peer-Reviewed Studies

Objective: To evaluate whether patient experience is positively associated with clinical safety and clinical effectiveness. Data sources: Evidence from 55 observational studies across diverse therapeutic areas. Results: Positive patient experience is robustly associated with higher levels of adherence to recommended treatment, better clinical outcomes, improved patient safety practices, and lower utilization of unnecessary healthcare services across primary and specialty care.

Why This Matters:Validates that investing in patient experience is not merely superficial customer service—it directly improves clinical outcomes, medication adherence, and patient safety across both outpatient clinics and large hospitals.

Patient Experience