Improving quality of care through the OECD Patient Reported Indicator Surveys (PaRIS)

Annex A. Design process of PaRIS

PaRIS followed a structured collaborative design process

PaRIS has been developed through a multi‑year design process (2018‑2024) combining extensive collaboration with national stakeholders, methodological development, and systematic cross‑country testing. This strong foundation ensures the reliability and comparability of the patient‑reported measures generated through Cycle 1. Before large‑scale implementation, PaRIS instruments underwent a multi‑country Field Trial (van den Berg et al., 2024[11]), which provided key evidence on sampling, questionnaire performance and fieldwork logistics. Feedback from national project managers, the former PaRIS‑SUR Consortium and other stakeholders informed refinements for the Main Survey.

The development of PaRIS questionnaires followed a rigorous process and collaborative procedure

The PaRIS conceptual framework was co‑developed with policymakers, patients, primary care professionals and academics (Valderas et al., 2024[12]). It reflects the understanding that patient outcomes and experiences depend not only on individual factors, but also on primary care organisation and broader system contexts. PaRIS uses two complementary questionnaires: the Patient Questionnaire (PaRIS‑PQ), covering PROMs, PREMs, health behaviours, demographics and chronic conditions, and the Primary Care Practice Questionnaire (PaRIS‑PCPQ), covering care organisation and chronic care management (Valderas et al., 2025[13]; Bloemeke-Cammin et al., 2024[14]). Both underwent translation and cognitive testing using the TRAP‑D model (Harkness, Vijver and Mohler, 2003[15]) and were piloted in the Field Trial before finalisation.

Key stakeholders have been engaged in PaRIS since its early stages

PaRIS was built through co‑creation with countries and experts to ensure the instruments reflected diverse health system priorities (Kendir et al., 2023[16]; Kendir et al., 2024[17]). National experts, academics, primary care professionals and patient representatives helped shape the conceptual framework so that indicators reflected what matters most to patient (Valderas et al., 2024[12]).

• Established in 2018, the Patient Advisory Panel ensured that PaRIS remained centred on patient priorities (Barlow-Noone et al., 2025[18]). The panel refined questionnaire items, advised on accessibility and respondent burden, and guided how findings should be communicated from a patient perspective.‌

• The Primary Care Professional Network ensured that the survey was feasible and aligned with routine clinical practice (Kendir et al., 2024[17]). Its members supported practice engagement, identified implementation challenges and helped interpret results in light of clinical workflows and care models.

• The International Expert Group provided methodological oversight throughout development and implementation. Its guidance ensured scientific rigour, cross‑country comparability and robust analytical approaches, supporting credible and policy‑relevant interpretation of results‌‌‌‍‌.