| Verified against primary record | |
| What they measure | The process of care, as distinct from its outcomes[1] |
|---|---|
| Also known as | PREMs |
| Distinction from satisfaction | Experience asks whether, or how often, aspects of care occurred; satisfaction asks whether expectations were met[2] |
| United States instrument | 32 items, 11 publicly reported measures, for discharges from 1 January 2025[3] |
| English survey, 2024 | 62,444 adults responding, 41 per cent response rate[4] |
| Records read | Two agency definitions and four national survey publications, 2 October 2026 |
| Independently reported | |
| Scope | Both national programmes sample from national inpatient frames, which excludes treatment abroad |
| Bands apply only to the rows beneath them. The 2024 English figure is a count of respondents; no invitation total is derived from it. | |
Patient-reported experience measures, usually abbreviated to PREMs, ask patients what actually happened during their care rather than how they felt about it. The distinction from satisfaction is not a refinement of wording. It is the whole point of the instrument, and it is why national health systems run PREM programmes rather than collecting satisfaction scores.
Experience, not satisfaction
The authoritative formulation of the difference is short. Patient satisfaction assesses patients’ expectations and whether those expectations were met, while patient experience considers whether, or how often, various aspects of care such as clear communication with providers occurred.[2] An experience item asks about an observable event. A satisfaction item asks for a judgement against an unstated personal standard.
Because an event either happened or it did not, experience items are comparable across patients with different expectations, and across hospitals serving different populations. That is the property satisfaction scores lack, and it is why the surveys are used because they are standardised, validated and reliable measures of patient experience, with questions that have been tested using a consistent methodology.[2]
Official guidance places PREMs alongside outcome measures as a pair: PROMs and PREMs are used to assess the quality of healthcare experiences, focusing on patients, with PROMs covering the outcomes of care as perceived by patients and PREMs assessing the process of care.[1]
The American instrument
The United States hospital survey describes itself as the first national, standardised, publicly reported survey of patients’ perspectives of hospital care. In the version effective for discharges from 1 January 2025 it is a 32-item instrument, comprising 22 questions that ask how often or whether patients experienced a critical aspect of hospital care, 3 screener items and 7 questions to adjust for the mix of patients across hospitals.[3]
It yields 11 publicly reported measures, 7 composite and 4 single-item: communication with nurses, communication with doctors, restfulness of the hospital environment, care coordination, responsiveness of hospital staff, communication about medicines, discharge information, cleanliness of the hospital environment, information about symptoms, overall hospital rating, and whether the patient would recommend the hospital.[3]
The administration rules are as significant as the questions. It is administered to a random sample of adult inpatients aged 18 and over between 48 hours and 42 days after discharge, across medical, surgical and maternity service lines, in any of six modes, each requiring multiple attempts to contact patients, and hospitals must survey patients throughout each month of the year. Public reporting requires a minimum of 25 completed surveys in a four-quarter period, and results appear four times each year. The results carry financial weight: the person and community engagement domain, which accounts for 25 per cent of the hospital value-based purchasing total performance score, is based on this survey.[3] It was developed with a federal research agency from 2002, implemented in October 2006, and first publicly reported in March 2008.
The English survey
England runs an annual adult inpatient survey, operated by the care regulator on behalf of the national commissioner and the health department, and coordinated through a dedicated survey centre. The 2024 round collected information on the experiences of 62,444 adults, with a 41 per cent response rate. Eligibility was adults who stayed in hospital for at least one night for tests, medical treatment or surgery during November 2024, aged 16 and over, and all data was collected between January and April 2025 using mixed modes.[4] The survey results were published on 9 September 2025, and a national qualitative report followed on 18 March 2026 as official statistics.[5][6]
An earlier round gives the scale of the trust-level coverage: the 2019 survey covered 143 NHS trusts with 76,915 completed questionnaires and an adjusted response rate of 45.3 per cent, with eligibility set by treatment during July 2019 and fieldwork running from August 2019 to January 2020.[7] The number of trusts in the 2024 round was not stated in the records read for this entry, so the 2019 figure is not carried forward.
Why no PREM covers treatment abroad
Both programmes define their universe by a national sampling frame. The American survey draws a random sample of inpatients discharged from participating hospitals in named service lines. The English survey draws from adults who stayed overnight in an NHS trust during a named month. A patient who travels abroad for private treatment is in neither frame, and would not be sampled by either instrument at any point.
This is a structural exclusion rather than an oversight, and it has a practical consequence. The experience measures that exist for domestic hospital care, with validated items, defined sampling, published response rates and in one case a financial consequence for the hospital, have no counterpart in medical travel. What exists instead is provider-collected satisfaction feedback, whose limits are set out in patient satisfaction in medical tourism.
The gap is in principle closable. A destination provider or an accreditation body could administer a validated experience instrument to a defined sample of international patients after discharge, and publish the response rate alongside the results. None found for this site does so.
See also
- Patient-reported outcome measures, the parallel instruments measuring the result of care
- Patient satisfaction in medical tourism, what is collected in this sector instead
- Medical tourism surveys, sampling frames and what they can support
- Medical tourism indexes, where experience data would belong if it existed
References
- Office for Health Improvement and Disparities. Patient-reported outcomes and experiences study. GOV.UK guidance, undated here because the stated publication date predates the publishing body. Verified against primary record: definitions of PROMs and PREMs read. Retrieved 2 October 2026.
- Agency for Healthcare Research and Quality. What is patient experience? Last reviewed March 2025. Verified against primary record: agency definition page opened and read. Retrieved 2 October 2026.
- Centers for Medicare and Medicaid Services. HCAHPS fact sheet. Posted December 2024, effective for discharges from 1 January 2025. Verified against primary record: item counts, reported measures, survey modes, eligibility window and value-based purchasing weight read in full. Retrieved 2 October 2026.
- NHS England. Adult inpatient experience survey 2024, national qualitative report. Verified against primary record: respondent count, response rate, eligibility and fieldwork dates read. Retrieved 2 October 2026.
- Care Quality Commission. Adult inpatient survey. Verified against primary record: publication date of the 2024 survey results read. Retrieved 2 October 2026.
- NHS England. Adult inpatient experience survey 2024, national qualitative report. Published 18 March 2026, official statistics. Verified against primary record: publication record and respondent count read. Retrieved 2 October 2026.
- Care Quality Commission. Adult inpatient survey 2019, statistical release. Published July 2020. Verified against primary record: trust count, completed questionnaires, adjusted response rate and fieldwork period read. Retrieved 2 October 2026.
Sourcing note: the two agency definitions and the four national survey publications were opened and read on 2 October 2026. The American instrument is described from its own current fact sheet, giving 32 items and 11 reported measures, rather than from the widely repeated figures of 29 items and 10 measures, which describe the version superseded for discharges from 1 January 2025. The figure of 62,444 is the number of respondents as published; no invitation total is derived from it. The trust count for the 2024 English round was not stated in the records read. The absence of any PREM covering treatment abroad is a conclusion drawn from the two programmes’ stated sampling frames; no source states it directly.