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Patient-reported outcome measures (PROMs)

Patient-reported outcome measures (PROMs) drumadmin

Patient-reported outcome measures (PROMs) are used to assess a patient’s health status at a particular point in time. PROMs are standardized, validated survey tools that assess health outcomes reported by patients, in areas such as general health and quality of life, or around specific symptoms, functional ability and physical, mental and social health. They can be completed either during an illness or while treating a health condition. In some cases, using pre- and post-event PROMs can help measure the impact of an intervention.

Learn about PROMs, CIHI’s PROMs Program and PROMs for hip and knee arthroplasty.

PROMs

PROMs overview

Learn about PROMs and how they can complement traditional data sources to inform policies, programs and value-based health care delivery.

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PROMs overview

PROMs overview kathschach

Patient-reported outcome measures (PROMs) are recognized as providing valuable and essential information for achieving health system goals. PROMs are measured from the patient’s perspective, and they can be used to more fully assess quality of care. Information from the patient’s perspective is essential to supporting a patient-centred approach to care. 

PROMs can also complement traditional sources of data — such as information derived from clinical and administrative data — to inform policies, programs and value-based health care delivery. They are essential to understanding whether health care services and procedures make a difference to patients’ health status and quality of life.

On this page:

What are PROMs?

PROMs are standardized, validated measurement tools that patients complete to provide information on aspects of their health status that are relevant to their quality of life, including symptoms, functionality and physical, mental and social health.

Many PROMs tools are available. They are categorized as

  • Generic: Used to assess general aspects of health and quality of life, and can be applied across different populations
  • Condition-specific: Used to assess outcomes that are specific or unique to particular diseases or sectors of care

Typically, generic and condition-specific tools are administered at the same time, as they provide complementary information.

Why collect PROMs?

PROMs provide valuable information that is essential for achieving health system goals and supporting a patient-centred approach to care:

  • Provide insights on the effectiveness of care from the patient’s perspective and allow us to understand whether health care services and procedures make a difference to patients’ health status and quality of life
  • Inform clinical practices, health services programming, planning and policies
  • Measure performance and evaluate effectiveness and quality improvement
  • Enrich existing information through data linkages (in a privacy-appropriate manner) with other data sources — such as clinical and administrative data, and patient-reported experience measures (PREMs) — to better inform decisions

Who uses PROMs?

PROMs are used by various stakeholders who interact directly and indirectly with a health care system:

  • Patients and clinicians: To inform clinical care, and to improve patient–provider communication and patient involvement in decision-making
  • Health system decision-makers: To inform health services programming, planning and policies, as well as for performance measurement and quality improvement initiatives
  • Researchers and policy-makers: To conduct comparative and cost-effectiveness analyses, as well as to answer other research questions

How to use PROMs

PROMs data can be used to supplement clinical and administrative outcomes at various levels of a health care system for the purpose of quality improvement:

  • Micro level (i.e., patient/clinician level): PROMs are used to screen for certain health issues or symptoms, monitor patients’ health status over time, facilitate shared decision-making and enhance patient-centred care and management (e.g., set expectations and goals, facilitate communication)
  • Meso level (i.e., hospital/organization level): Aggregate PROMs data can be used to identify, assess and monitor health outcomes in specific patient populations (e.g., identify gaps in care, evaluate health programs, benchmark, measure key performance indicators)
  • Macro level (i.e., health system level): PROMs are used to evaluate and enhance overall health system performance through evaluation and policy development (e.g., compare across jurisdictions or over time, assess value-based health care and priorities, support health policy decision-making that takes into account patients’ perspective and priorities)

Contact us

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proms@cihi.ca

CIHI’s PROMs Program

CIHI’s PROMs Program kathschach

A common approach to collecting and reporting patient-reported outcome measures (PROMs) data provides more comparable data — regionally, nationally and internationally — with which to drive health system enhancements. In response to stakeholder interest, CIHI works with a broad range of stakeholders to provide leadership to advance standardized approaches to PROMs in Canada.

In 2015, CIHI hosted a pan-Canadian PROMs Forum, which launched CIHI’s PROMs Program to support the development of PROMs data collection standards and reporting in priority areas. CIHI developed a PROMs focus on hip and knee replacement surgeries.

CIHI’s PROMs Program helped to do the following: identify priority clinical areas and topics for the routine collection and reporting of PROMs data in Canada; support the development of PROMs data collection standards and tools; convene stakeholders and facilitate collaboration across jurisdictions; advance a common approach to PROMs data collection and reporting; and promote the ongoing and routine use of PROMs and comparative reporting of PROMs data.

Additional information is available in CIHI’s PROMs Background Document (PDF). 

As of April 1, 2025, CIHI has made the decision to change its involvement related to the PROMs Program. CIHI has thoughtfully evaluated programs and services in light of the evolving information needs of health systems. CIHI will focus on existing commitments in PROMs on hip and knee replacement surgeries, and it will step back from PROMs work outside of this clinical area. CIHI will also continue to support sub-licensing of PROMs tools, including the EQ-5D-5L, Oxford Hip Score (OHS) and Oxford Knee Score (OKS).

CIHI values the collaborative achievements accomplished with partners, and it recognizes the importance of PROMs data to providing valuable information for supporting patient-centred health care.

Collaboration and partnerships

The use of PROMs in Canada continues to evolve. Expanding the collection of PROMs to include more patients and more provinces and territories is needed to enhance the utility of these measures for health care planners and clinicians.

To gain insight into the application of PROMs in Canada, CIHI conducted an environmental scan on the use and value of generic PROMs and how they are being implemented and planned in Canadian jurisdictions. The summary findings and recommendations from this work are available upon request.  

If you have questions or would like to learn more, email proms@cihi.ca.

OECD Patient-Reported Indicator Surveys (PaRIS) initiative

The Organisation for Economic Co-operation and Development (OECD) Patient-Reported Indicator Surveys (PaRIS) initiative identified the need for PROMs reporting to better monitor health system performance and to drive continuous improvement.

The OECD established the international Working Group on Patient-Reported Indicators for Hip and Knee Replacement Surgery to build consensus on common approaches for PROMs collection and reporting. The working group’s priorities have included developing indicators for comparable reporting, developing international data collection standards, and reporting internationally comparative PROMs data for hip and knee replacement surgery.

Members of the group have included patient representatives, clinicians, national arthroplasty registries, the International Society of Arthroplasty Registries (ISAR), experts in PROMs measurement and government representatives from several OECD member countries. From 2017 to 2024, CIHI co-led this working group, and it partnered with the OECD to release international reporting of hip and knee PROMs data in 2019, 2021, 2023 and 2025.

Featured materials

PROMs Background Document

An overview of PROMs and some examples of PROMs use nationally and internationally.

Download PDF

International Data Collection Guidelines

International guidelines on PROMs data collection in hip and knee replacement procedures in OECD member and partner countries.

Download PDF

OECD’s Health at a Glance 

Key indicators of health system performance across OECD member and partner countries and reporting on PROMs data in acute care for hip and knee replacements.

Go to OECD’s Health at a Glance

International assessment of the use and results of PROMs for hip and knee replacements

Findings of the OECD working group on hip and knee replacement surgery.

Go to OECD working paper

Related resources

Contact us

Email us at

proms@cihi.ca

Hip and knee arthroplasty PROMs

Hip and knee arthroplasty PROMs kathschach

Hip and knee replacements improve mobility and quality of life for patients, particularly those who have spent years managing debilitating pain from osteoarthritis. These surgeries are among the top 3 most-performed inpatient surgeries in Canada. Hip and knee replacements were identified as initial areas of focus for PROMs because

  • PROMs programs currently exist in these areas across Canada and internationally
  • There is strong support from the clinical community
  • Evidence supports expected improvements in pain, function and quality of life after surgery
  • A high number of patients undergo these surgeries, resulting in substantial costs to health systems

On this page:

National standards

CIHI published the Patient-Reported Outcome Measures Data Collection Manual: Hip and Knee Arthroplasty in 2019 and updated it in 2021. This manual outlines national data collection guidelines and recommendations for PROMs instruments:

  • EQ-5D-5L: A standardized instrument developed by the EuroQol Group that measures health-related quality of life
  • Oxford Hip Score (OHS) and Oxford Knee Score (OKS): Validated measures developed by Oxford University Innovations to assess pain and functioning in patients undergoing hip or knee arthroplasty
  • 2 survey collection time points: Pre-surgery and 1 year post-surgery
  • Minimum data set: Additional information to collect with a PROMs tool

CIHI’s Canadian Joint Replacement Registry (CJRR) Advisory Committee and PROMs Hip and Knee Replacements Working Group have endorsed these standards. CIHI is facilitating the uptake of these national PROMs standards to enable pan-Canadian PROMs comparative reporting.

Adoption of national standards for hip and knee PROMs in Canada

Ontario, Nova Scotia, Alberta* and Saskatchewan adopted the standards in 2018, 2019, 2023 and 2024, respectively. Manitoba* and British Columbia adopted the standards in 2020.

Note
* Long-standing provincial programs.

Patient-Reported Outcome Measures Data Collection Manual: Hip and Knee Arthroplasty, 2021

Guidelines for survey time points, a minimum data set (MDS) and recommended PROMs instruments

Download the manual (PDF)

About the data

For more information about the data, visit the PROMs metadata page. Researchers, decision-makers and health managers can request specific PROMs data through the Access Data Inquiry Form.

Visit CIHI’s Make a data request page for more information. 

Licensing

CIHI has obtained licences to use the OHS, OKS and EQ-5D-5L, and we are permitted to sub-licence these instruments to Canadian hospitals and providers for use in routine care (i.e., not for research or commercial purposes). In addition to Canadian English and French versions, validated translations in other languages of the tools are also available. To register for these PROMs tools, fill in the appropriate forms below and email them to proms@cihi.ca.

EQ-5D-5L registration form

Used to confirm intent to collect data from patients in routine care using the EQ-5D-5L (paper and/or REDCap electronic versions) under CIHI’s national licence for this instrument.

Download the form (PDF) 

Oxford Hip Score/Oxford Knee Score registration form

Used to confirm intent to collect data from patients in routine care using the OHS and OKS (paper and/or REDCap electronic versions) under CIHI’s national licence for these instruments.

Download the form (PDF)

Reporting

Understanding a patient’s self-reported outcomes is integral to improving patient-centred care. PROMs can be used with other health system performance indicators to drive improvements in Canada’s health care systems.

In collaboration with pan-Canadian and international partners, CIHI provides comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health. Learn more through the following reports: 

CJRR annual report

Explore the latest information on hip and knee replacements in Canada, including patient demographics, surgical statistics, costs, patient-reported outcomes, data tables and revision risk curves.

Download the report (PDF)

Using patient-reported data to better assess quality of care for hip and knee replacements

This report demonstrates the feasibility and value of combining clinical outcomes, patient-reported experience measures (PREMs), PROMs and costing data.

Read report 

OECD Health at a Glance 

Key indicators of health system performance across OECD member and partner countries and reporting on PROMs data in acute care for hip and knee replacements

Visit OECD Health at a Glance 

How would we know whether joint replacements are successful if we do not ask patients? 

Explore how PROMs data can be used to help identify factors that lead to better care and what contributes to a patient’s perception of surgical success.

Visit the Healthcare Quarterly article 

Contact us

Contact us at

proms@cihi.ca

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