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

4. Long term-impact and sustainability

Across countries, PaRIS indicators are starting to be built into national measurement and quality monitoring. Many countries have begun routine PREMs and PROMs collection, integrating them into national registers and are planning to link indicators to accreditation. Countries are also putting in place governance arrangements, budget lines and data pipelines to sustain the work through political and fiscal changes. Participation in Cycle 2 is reinforcing these efforts by providing a longitudinal dataset that supports trend analysis, comparison and continued use.

PaRIS was built to systematically measure healthcare system performance (in delivering primary care) from people’s perspective. Its overall goal is to improve the quality of primary care. The long-term impact of PaRIS will depend on the systematic collection of data, the effective use of these data to inform health policies and practices, and the sustained implementation of quality monitoring strategies. Such quality assurance strategies can focus on “setting standards” through regulation of pathways, “monitoring” through feedback and accreditation, and “assuring improvement” through public reporting (Eu et al., 2019[10]).

Countries have been working to ensure the long-term impact of PaRIS through sustainable structures which institutionalise the collection and use of PROMs and PREMs data. While this requires a forward-looking perspective, country examples show how PaRIS can stimulate and support broader quality measurement, improvement and assurance activities in the long term.

Eight countries reported embedding or planning to embed PaRIS indicators into national measurement and quality monitoring systems

Countries are planning to embed or have already begun embedding, the routine use of PaRIS indicators in broader quality monitoring at the national and local level. Australia is exploring ways to embed PaRIS within its broader work on chronic conditions and primary care, and to integrate it into national quality and performance improvement systems. Prior to PaRIS, Greece lacked quality indicators for primary healthcare. As such, Greece is developing stronger indicators to measure co‑ordination across primary healthcare, drawing on the indicators used in PaRIS. Norway is testing PaRIS indicators to embed a selected set in the general practice PREM survey. This approach will generate patient reported indicators at the municipality level, across all municipalities, creating comparable measures for general practice performance including patient-perceived collaboration within and across healthcare levels. These data will support policy and practice, including the work of the Ministry‑appointed committee on health system organisation, which is due to present its recommendations in 2026.

Portugal is reviewing its accreditation processes and is working to include PREMs in the accreditation cycle so that patient experience becomes part of routine oversight. Iceland is adding PaRIS‑derived questions to an ongoing government service survey run by the Ministry of Economics to track year‑on‑year changes in how people access and experience services, partly influenced by PaRIS. Italy is revising its National Guarantee System and plans to add indicators that all regions can feasibly measure, using PaRIS as the foundation for selection. Additionally, selected PREMs indicators, based on PaRIS, are being prepared as a non‑core, pilot measure with the aim of moving them to core status if feasible, and unmet needs are already included among non‑core indicators. Authorities in Italy are also planning to use Cycle 2 of PaRIS to examine the equity of recently introduced reforms in community healthcare. Using longitudinal data across cycles they plan to explore whether patient‑reported experience is improving consistently across the country, after the rollout of new community health centres and related digital health services. Italy is also exploring including of at least one PaRIS indicator in periodic national statistics surveys to secure regular measurement. Luxembourg is using PaRIS to inform the creation of patient‑reported indicators in its national HSPA, with emphasis on patient empowerment and integrated care. Slovenia has established a new national agency for quality in healthcare, and the current project team has proposed that it prioritise PaRIS indicators for long-term monitoring, including tracking implementation of new legislation such as the digital health law. The proposal under discussion is to run short, continuous surveys using PaRIS‑based items at the individual level. Wales is using PaRIS to monitor the impact of changes made to the General Medical Services contract to improve quality and continuity of care, with baseline analyses complete and metrics ready to auto‑populate in Cycle 2. In parallel, Welsh officials are considering PaRIS as a five‑year touchpoint to complement yearly reporting for the Patient Experience Framework. Some countries are working towards institutionalisation of PaRIS to ensure long term sustainability.

Countries are exploring possible options to institutionalise the collection of PROMs and PREMs by developing new structures or changing existing governance structures. Norway is exploring the possible inclusion of PREMs and PROMs in national registries to enable continuous measurement. Such an arrangement would be placed at the National Institute of Public Health and allow data linkage with individual level data on PREMS and PROMs across healthcare levels over time. Slovenia implemented a National Law on Quality of Care, which is aligned with PaRIS, allowing the collection of PROMs and PREMs data. Portugal is implementing structures to make PaRIS stable and institutional by preparing a ministerial decree that will formalise governance, set out clear responsibilities across agencies, and tie the work to explicit policy objectives. The draft is ready for submission to the ministry, with the intent to secure continuity at the institutional level so that implementation is maintained regardless of changes in government.

Participation in Cycle 2 has played a key role in sustaining momentum and integrating PaRIS into broader quality improvement and assurance frameworks

Countries are using participation in Cycle 2 to keep momentum and make PaRIS part of routine work. Australia aims to continue participating in future PaRIS cycles to build a time‑series dataset that supports analysis of national and international trends in PROMs and PREMs. These data will enable ongoing monitoring and help assess the impact of primary care reforms implemented by policymakers and healthcare providers. Czechia sees Cycle 2 as essential because repeat collection is needed and will use the new data to support primary care reform planned for 2035. Greece aims to continue PaRIS to address quality issues in primary care. Italy plans to use data from Cycle 1 as a baseline to track programme changes in Cycle 2. Norway has PROMs and PREMs data collection, including PaRIS, as a policy priority for the coming decade. Longitudinal results derived from multiple cycles will be valued and Norway is planning how it will apply Cycle 2 outputs, including in evaluation of policy initiatives informed by PaRIS and other knowledge sources. Slovenia plans to stay in PaRIS long term and is already preparing suggestions for the next cycle and has also reported that strong uptake of individual feedback by practices is a key motivator. Wales has set up monitoring streams that will auto populate when Cycle 2 data arrive. Sustainability efforts are hampered in countries where Cycle 2 remained uncertain.