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2013, the NHS Outcomes Framework will form part of the way in which the
Secretary of State will hold the new NHS Commissioning Board to account for the
commissioning system in the English NHS.
Several studies have reported improvements following systematic gathering of
patient feedback by hospitals [ 38 – 45 ]. A report by the Picker Institute Europe on
trends from 26 national patient surveys, carried out under the auspices of the NHS
patient survey program in England between 2002 and 2007 to assess the quality of
NHS care through patients’ eyes, has explored the experience of care of nearly one
and a half million NHS patients [ 46 ]. The report indicates that despite improve-
ments over the time period, the service as a whole is still far from patient-centered.
The most signifi cant problem highlighted was the failure of clinical staff to provide
active support for patient engagement. This demonstrates that further improvement
and the routine incorporation of patient experience into NHS services is required.
Importance of PREMs in Chronic Diseases: The Diabetes
Experience
The management of chronic diseases necessitates a high degree of self-management
requiring patient concordance and understanding of their condition. In addition
effective self-management is facilitated by patients having confi dence in the advice
and strategies proposed by their healthcare team and a positive experience of care.
A US study of 51,129 patients with a chronic disease (asthma, diabetes, and cardio-
vascular disease) used patient surveys to assess the relationship between clinical
care metrics and patient experiences of care among patients with chronic disease. In
this study, performance on patient experiences of care measures was highest for the
quality of clinical interactions (88.5) and lowest for delivery of self-management
support (68.8; scale 0–100) [ 47 ]. PREMs are in development for a variety of chronic
diseases including: chronic obstructive pulmonary disease [ 48 ] and chronic heart
failure [ 49 ]. Currently the most advanced PREMs have been developed for diabetes
for both adult and younger patients.
The Diabetes Patient Experience Project (DPEP) has developed PREMs tools to
assess experiences of adult patients with diabetes about their continuing care and inpa-
tient stays [ 50 ]. Using either a postal or online questionnaire, patients are asked about
the planning and provision of their diabetes care. With regard to planning, the tools
include questions that cover: whether during appointments patients were able to dis-
cuss their ideas for managing their condition and their goals; whether they were given
dietary and physical activity advice; whether a printed copy of their care plan was
made available; whether they were listened to and had things explained clearly; and
whether the appointments made them feel more confi dent about managing their dia-
betes. With regard to provision of care, the tools include questions that cover: whether
they received confl icting information; whether they had to repeat important informa-
tion provided previously; whether they had a contact number to call if concerned;
M. Bukhari