Validation of the PREM-MSZ resulting in the PREM-Q8: a generic patient-reported experience measure for outpatient care.
5 affiliations
- 1Xpert Clinic, Eindhoven, The Netherlands [email protected].
- 2Plastic, Reconstructive and Hand Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
- 3Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
- 4Xpert Clinic, Eindhoven, The Netherlands.
- 5Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Abstract
Introduction Patient experience is a key measure of healthcare quality, but many widely used Patient-Reported Experience Measures (PREMs) lack formal validation. The PREM-MSZ (‘Medical Specialist Care’) is a widely used, Dutch, policy-embedded generic PREM for hospital and outpatient care that has not yet been formally validated or translated. This study aimed to develop Dutch and English-translated brief and generic PREM based on the PREM-MSZ and evaluate its content and construct validity in outpatient care.Methods Items were selected from the PREM-MSZ based on predefined criteria for generalisability, relevance, actionability and capturing experience. Cognitive interviews were used to assess and improve clarity, relevance and comprehensiveness. Construct validity was evaluated by analysing floor and ceiling effects, non-relevance rates and known-group validity using the Mann-Whitney U and Cliff’s delta. To test the known-groups hypothesis, we compared patients classified as promoters or detractors using the Net Promoter Score.Results We selected eight questions based on predefined criteria and evaluated them through cognitive interviews with eight participants, confirming strong content validity. Psychometric item analyses were conducted on data from 31 120 patients across more than 25 outpatient locations and multiple medical specialties. No floor effects were found. Ceiling effects were observed mainly among promoters; among detractors, no ceiling effects were found. Known-groups analysis showed that promoters scored significantly higher than detractors on all items with large effect sizes (Cliff’s Delta>=0.75), indicating the instrument’s ability to capture meaningful differences in patient experience. Based on these findings, six closed-ended questions were retained to form the final PREM-Q8, and two open-ended questions were added to improve actionability.Conclusions The PREM-Q8 provides initial evidence of content and construct validity and offers a brief, generic instrument for measuring patient experience in outpatient care, building on the widely used PREM-MSZ.
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BibTeX
@article{stege2026validation,
title = {{Validation of the PREM-MSZ resulting in the PREM-Q8: a generic patient-reported experience measure for outpatient care.}},
author = {Marloes Hendrina Paulina Ter Stege and Kim Phi Luong and Harm Pieter Slijper and Ruud W Selles},
journal = {BMJ open quality},
year = {2026},
month = oct,
doi = {10.1136/bmjoq-2026-004294},
url = {https://europepmc.org/article/MED/42906969},
note = {CC BY},
}
RIS
TY - JOUR
TI - Validation of the PREM-MSZ resulting in the PREM-Q8: a generic patient-reported experience measure for outpatient care.
AU - Marloes Hendrina Paulina Ter Stege
AU - Kim Phi Luong
AU - Harm Pieter Slijper
AU - Ruud W Selles
PY - 2026
DA - 2026/10/21
JO - BMJ open quality
DO - 10.1136/bmjoq-2026-004294
UR - https://europepmc.org/article/MED/42906969
AB - Introduction Patient experience is a key measure of healthcare quality, but many widely used Patient-Reported Experience Measures (PREMs) lack formal validation. The PREM-MSZ (‘Medical Specialist Care’) is a widely used, Dutch, policy-embedded generic PREM for hospital and outpatient care that has not yet been formally validated or translated. This study aimed to develop Dutch and English-translated brief and generic PREM based on the PREM-MSZ and evaluate its content and construct validity in outpatient care.Methods Items were selected from the PREM-MSZ based on predefined criteria for generalisability, relevance, actionability and capturing experience. Cognitive interviews were used to assess and improve clarity, relevance and comprehensiveness. Construct validity was evaluated by analysing floor and ceiling effects, non-relevance rates and known-group validity using the Mann-Whitney U and Cliff’s delta. To test the known-groups hypothesis, we compared patients classified as promoters or detractors using the Net Promoter Score.Results We selected eight questions based on predefined criteria and evaluated them through cognitive interviews with eight participants, confirming strong content validity. Psychometric item analyses were conducted on data from 31 120 patients across more than 25 outpatient locations and multiple medical specialties. No floor effects were found. Ceiling effects were observed mainly among promoters; among detractors, no ceiling effects were found. Known-groups analysis showed that promoters scored significantly higher than detractors on all items with large effect sizes (Cliff’s Delta>=0.75), indicating the instrument’s ability to capture meaningful differences in patient experience. Based on these findings, six closed-ended questions were retained to form the final PREM-Q8, and two open-ended questions were added to improve actionability.Conclusions The PREM-Q8 provides initial evidence of content and construct validity and offers a brief, generic instrument for measuring patient experience in outpatient care, building on the widely used PREM-MSZ.
SN - 2399-6641
ER -