Patient-reported experience measures (PREMs): Frequently asked questions

Understanding a patient’s experience when they received health care is integral to improving patient-centred care and assessing the performance of our health systems. CIHI’s Canadian Patient Experiences Survey — Inpatient Care (CPES-IC) aims to improve the quality of care received in Canadian hospitals by providing patients, health care professionals and individual hospitals with standardized and comparable information on patients’ feedback about their acute care hospital experience.

In addition to gaining valuable knowledge about their own care processes, participating hospitals can use patient experience data alongside other health indicators to see how they compare with other hospitals, both in the same jurisdiction and across the country.

For more information about the use of patient-centred measurement data, check out CIHI’s report Patient experience in Canadian hospitals, 2022.

How were the patient-reported experience measures (PREMs) selected for public reporting?

CIHI undertook a comprehensive process to ensure that these measures reflect patient, clinician, hospital and health system voices and drive improvement in patient-centred care. We consulted with our stakeholders to develop a set of guiding principles to ensure that the measures for public reporting

Reflect patient, hospital and system-level voices, emphasizing the patient voice
Represent various themes of patient experience
Drive improvement in patient-centred care and support benchmarking across hospitals

Relying on these principles, we worked with health system stakeholders and the Canadian public to arrive at measures that are publicly reported in CIHI’s Your Health System web tool.

For more details on the selection process, email prems@cihi.ca.

Where can I find my hospital’s or jurisdiction’s results?

There are 4 ways you can get results

Your Health System (YHS) web tool
5 of the 23 PREMs from the CPES-IC are publicly available in CIHI’s YHS web tool:
- Communication With Nurses
- Communication With Doctors
- Involvement in Decision-Making and Treatment Options
- Information and Understanding When Leaving the Hospital
- Overall Hospital Experience
  
  All 5 measures can be found under the Person-Centredness theme in Your Health System: In Depth. The Overall Hospital Experience measure is also reported under the Quality of Care theme in Your Health System: In Brief.
Public reports
CIHI has also released patient experience survey results through the following reports:
- Patient experience in Canadian hospitals, 2022
- Impact of COVID-19 on patient experience in acute care hospitals
Canadian Patient Experiences Survey (CPES): Comparative Results tool
The CPES: Comparative Results tool provides authorized users with access to results from CIHI’s Canadian Patient Experiences Reporting System (CPERS) in a private online environment. CPERS receives data about patient experiences from hospitals or jurisdictions that administer the CPES-IC. The purpose of the CPES: Comparative Results tool is to provide hospital-level comparative results in order to support quality improvement efforts. If you are a submitting hospital and would like to get access, write to help@cihi.ca.
Data Request Program
Researchers, decision-makers and health managers can request specific data from CPERS though CIHI’s Data Request Program. Complete our initial Data Inquiry Form to begin. We will then send you the formal Data Request Form to collect more information.

To learn more about CPERS data, please visit CIHI’s Patient Experience web page or email prems@cihi.ca.

Why are my results different from CIHI’s results?

To enhance the comparability of results across jurisdictions and peer hospitals, patient experience measures in YHS, the CPES: Comparative Results tool and the All Data Export file have been adjusted for survey design, non-response, mode of survey completion and service line; they have also been age–sex standardized, where applicable, to the hospital population. For more information on these methodologies, please refer to the methodology notes (PDF).

Survey administration

Which Canadian jurisdictions have submitted Canadian Patient Experiences Survey — Inpatient Care (CPES-IC) data to CIHI?

See CIHI’s web page about the patient experiences reporting system.

Who is eligible to complete the CPES-IC?

The CPES-IC was designed for use in inpatient acute care across 3 hospital service lines: medical, surgical and maternity. Adult patients who received these types of services in an acute care hospital are eligible to complete the CPES-IC. General eligibility requirements for patients include the following:

18 years and older at the time of admission
Alive at the time of discharge
Occupied an inpatient care bed

Patients are not eligible if they received services in a specialized care facility (e.g., psychiatric or rehabilitation units/hospitals). Please refer to the CPES-IC Procedure Manual (PDF) for more information about the eligible population.

How is the CPES-IC survey administered?

The CPES-IC is administered at the facility, region and/or jurisdiction level, or through a commercial vendor. Administration of the survey varies by jurisdiction. CIHI’s CPES-IC Procedure Manual (PDF) provides standards and guidelines for administering the survey.

Why is it important to administer the survey in adherence to survey standards?

A consistent approach to administering the CPES-IC will allow results to be compared across Canada. The protocols are designed to increase patients’ response rates and to minimize proxy and response bias. It is important to administer the CPES-IC in its entirety and in adherence with the survey standards as outlined in the CPES-IC Procedure Manual (PDF). This helps to maintain consistency among hospitals and jurisdictions and allows for standardized comparative reporting. If you have any questions about the standards, please email prems@cihi.ca.

Patient participation

Will I get a survey if I’m in the hospital?

If you’re eligible for the Canadian Patient Experiences Survey — Inpatient Care (CPES-IC), you may be randomly selected from a group of patients who also recently received the same type of treatment as you (surgical, medical or maternity services) at the same hospital. If you’re selected, you’ll get the survey between 48 hours and 1 month after you leave the hospital. It’s up to you whether you do the survey, and you can answer only the questions you want to.

How is my information being protected?

If you do the survey, the organization that gave it to you may send your answers to the Canadian Institute for Health Information (CIHI). If CIHI gets your answers, we’ll store them in the Canadian Patient Experiences Reporting System (CPERS), one of our databases. We’ll use any information we get in a way that obeys our Privacy Policy, 2010. This document sets out our rules for how we treat personal health information. Our Privacy and Security Program meets the highest standards for keeping health information safe and confidential.

How are my survey answers used?

Your answers tell us about your experiences in the hospital. Service providers, hospital decision-makers, researchers and funders will use your answers — along with answers from other patients and additional information — to assess how well the health system is performing, and to improve patient-centred care and patient outcomes in Canada.

We’ve combined the answers we’ve received from patients who’ve done the survey and posted high-level results in our Your Health System web tool. You can find them on Your Health System: In Depth under the Person-Centredness theme, and on Your Health System: In Brief under the Quality of Care theme.

How can I learn more about how CIHI is working with patients?

We want to reflect patient voices in our work, so we’re including patients in more and more of our projects. When patients share their expertise, their advice and their journey with us, they give us unique insights that help us to understand our data. Patients’ experiences help to explain our findings, and they make sure that our work is relevant to decision-makers throughout the health care system.

To learn more, visit CIHI’s Working with patients and families page or email patientengagement@cihi.ca.

Survey development and methodology

What factors were considered when developing the Canadian Patient Experiences Survey — Inpatient Care (CPES-IC)?

CIHI, in partnership with stakeholders, sought to develop the first pan-Canadian patient experiences survey for inpatient care. The goal was to provide a national survey standard for comparative patient experience measures to facilitate benchmarking for quality improvement.

CIHI worked with the Inter-Jurisdictional Patient-Centred Measurement Advisory Group (IJG) and other national experts to review the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a standard American patient experience survey, and identify additional questions to include in the CPES-IC.

CIHI used a multi-step process to select new questions. First, CIHI and the IJG decided on important areas (domains) that were not covered in the HCAHPS questionnaire. This was done by reviewing existing patient experience survey questions used in Canada, the scientific literature and available survey data. Next, we conducted an extensive review of existing questionnaires used around the world related to those areas/domains and identified related questions. Experts from across the country reviewed existing questions and drafted new questions related to key themes in the domains. Subsequently, the new questions were reviewed with patients and then cognitively tested (May 2013) and pilot tested (September 2013) in both English and French to ensure that they are appropriate and understandable.

CIHI continues to work with external stakeholders and experts to ensure that the survey still meets the needs of health jurisdictions, hospitals and data users and that it reflects the priorities of patients in Canadian hospitals.

Learn more about the development of the survey.

Has the CPES-IC been validated?

The CPES-IC has been validated and is endorsed by the Health Standards Organization and Accreditation Canada for patient experience surveying. CIHI validated the survey questions and measures using data from our Canadian Patient Experiences Reporting System (CPERS) database. 2 sources of evidence were used to establish validity: the internal structure of the survey, and the relationships between different types of measures of patient experience from the survey. From this validation work, the CPES-IC dimensions had good overall fit at the patient level. Prior to validation, we also conducted pilot testing and cognitive testing of the survey; additional details about the development of the CPES-IC can be found in this paper about the development of the survey.

Why are survey results adjusted for mode and service line?

The CPES-IC is currently completed in 3 modes: mail, online and telephone. The mode of survey completion may impact results by influencing the composition of respondents and the way respondents answer questions. Furthermore, the impact of mode of survey completion on CPES-IC results differs by the type of service a patient has received. Therefore, to account for the influence of these factors, CIHI has quantified the impact of mode and service line on CPES-IC question responses and developed mode and service line adjustments (XLSX) for the CPES-IC survey.

Where can I find methodology information for the patient-reported experience measures (PREMs)?

Technical details (e.g., measure definitions, methodologies) for each PREM in CIHI’s Your Health System web tool can be found on CIHI’s Indicators web page. Additional details to support interpretation of CPES-IC results and to provide considerations when drawing comparisons can be found in the PREMs methodology notes (PDF).

For more information on the mode and service line adjustment values that are applied to the PREMs, see CPES-IC Mode and Service Line Adjustments — Data Tables (XLSX).

CPERS database

What is the Canadian Patient Experiences Reporting System (CPERS)?

See CIHI’s web page about CPERS.

How can I access additional Canadian Patient Experiences Survey — Inpatient Care (CPES-IC) data?

Hospitals that submit CPES-IC data to CPERS can request access to the Canadian Patient Experiences Survey (CPES): Comparative Results tool. This tool enables authorized users to assess inpatient experiences at their hospital, compare their results with those of other hospitals and across geographic levels, and explore trends over time.

If you work at a hospital that submits data to CPERS, you can request access to the CPES: Comparative Results tool through your CIHI profile. If you do not have a CIHI profile, please create one by visiting cihi.ca and clicking Register at the top of page. For questions about access, please email help@cihi.ca.

Researchers, decision-makers and health managers can request specific data from CPERS though CIHI’s Data Request Program. Complete our initial Data Inquiry Form to begin. We will then send you the formal Data Request Form to collect more information.

To learn more about CPERS data, please visit CIHI’s website or email prems@cihi.ca

How can I learn more about CIHI’s patient experience data?

Please visit CIHI’s website or email prems@cihi.ca.