Value based health and care action plan: measurement framework

Action 4

The Scottish Government will support development of a national Person Reported Experience Measure (PREM) to improve delivery of person-centred care.

Progress to date and future priorities

After extensive engagement and testing with service users, health and care professionals and international experts in person-centred research and measurement, a six-question PREM survey has been developed. These align with the five previously identified^[7] domains of person-centred care, personalisation, experience of care, enablement, wellbeing, and coordination.

The future focus is on a nationally coordinated approach to collecting and using PREMs data to support individual patient care and service improvement. A national PROMs and PREMs platform is being developed and tested within Healthcare Improvement Scotland’s Right Decision Service suite of applications and will work in an integrated way within MyCare.Scot to support individual patient care as well as analysis of population-level data for service improvement purposes. The Right Decision Service PROMs and PREMs platform will work alongside and complement other sources of patient experience data such as Care Opinion.

Monitoring metrics

The monitoring metrics for Action 4 are drawn entirely from survey data collected from health and care professionals. These metrics describe the extent to which professionals use different forms of patient feedback to inform the delivery of person‑centred care.

Metric 4.1: Around a quarter of health and care professionals surveyed reported using feedback from PREMs^[8] to inform their delivery of person-centred care very often (4%), often (9%) or occasionally (11%).

Metric 4.2: Around one-in-ten health and care professionals surveyed report using feedback from shared decision-making measurement tools such as CollaboRATE or SURE to inform their delivery of person-centred care very often (1%), often (3%) or occasionally (6%).

Metric 4.3: Around six-in-ten health and care professionals surveyed report using feedback from patient experience surveys to inform their delivery of person-centred care very often (8%), often (20%) or occasionally (34%).

Metric 4.4: Around four-in-ten health and care professionals surveyed report using feedback from Care Opinion to inform their delivery of person-centred care very often (7%), often (14%) or occasionally (22%).^[9]

Metric 4.5:Around one-in-ten health and care professionals surveyed report using feedback from the NEAR ME end of consultation survey to inform their delivery of person-centred care often (2%) or occasionally (7%).

Action 5

The Scottish Government and delivery partners will explore digital capture and use of Patient Reported Outcome Measures (PROMS) and specific outcome measures to drive improvement and better value care.

Progress to date and future priorities

The Scottish Government Realistic Medicine Policy Unit has engaged the RDS, as part of Healthcare Improvement Scotland, to draft a series of scoping reports to outlining the current landscape for PROMs development in Scotland and identifying recommended next steps. Drawing on findings from a desk-based evidence review, technical infrastructure analysis, landscape mapping and stakeholder engagement, the reports recommend progressing towards a nationally coordinated approach to PROMs development. This recommendation was endorsed by the VBH&C Implementation Group.

The recommendation has been initiated through the inauguration of a new National PROMs and PREMS Implementation Steering Group (N-PROMIS), whose remit is to provide support, guidance and governance to ensure successful delivery. An implementation plan for the period April 2025 to March 2029 has been agreed in principle by N-PROMIS, which focuses on three work strands: 1) transformational change, 2) data and evidence and 3) technology infrastructure.

RDS has secured funding from the Chief Pharmacist’s Office to implement core elements of the technology infrastructure. A Minimum Viable Product has been successfully tested, and the funding will support further essential development, piloting, integration with MyCare.scot, and wider implementation by March 2029. The RDS and N-PROMIS Steering Group are supporting the Scottish Government Realistic Medicine team to develop a business case for fuller technology development and for implementation of the proposed data and evidence and transformational change work strands.

Monitoring metric

The monitoring metric for Action 5 is based on survey data collected from health and care professionals. This metric focuses on the extent to which professionals use feedback from PROMs to inform their delivery of person‑centred care.

Metric 5.1: Around a quarter of health and care professionals surveyed reported using feedback from PROMs to inform their delivery of person-centred care very often (6%), often (8%) or occasionally (11%).

Supplementary c ase study :A case study showcasing the integration of PROMs as a part of a Polypharmacy Management project.

Integration of PROMs in the ‘implementing stimulating innovation in the management of polypharmacy and adherence through the years’ (iSIMPATHY) project

The iSIMPATHY project ran from September 2019 to March 2023. A total of 6,481 patients participated in medicines reviews in Scotland, Northern Ireland and the Republic of Ireland over the lifetime of the project. The iSIMPATHY programme incorporated PROMs as a central component of its person‑ centred approach to polypharmacy and medication review. Using PROMs the project captured patients’ own assessments of their symptoms, wellbeing and daily functioning.

PROMs were used during the structured 7‑Steps medication review process, enabling clinicians to tailor discussions and decisions in line with what mattered most to individuals. By identifying the impact of medicines on patient‑experienced outcomes, PROMs supported clinicians in adjusting treatment regimens to enhance both effectiveness and safety.

The iSIMPATHY project demonstrates how digitally enabled PROMs can be embedded into routine care to support improvement and more sustainable practice. The structured use of patient‑reported data enabled clinicians to identify avoidable harm, prioritise medication changes and improve the appropriateness of treatments.