Multicentric Design and Validation of a Set of Democratized Hospital Patient Reported Experience Measures in Spain

In recent years, an increasing number of Patient Reported Experience Measures (PREMs) have been enabled to explore and guide improvements. The aim is to establish a set of questionnaires for assessing hospitals care, share results, and perform a transparent formal cognitive and psychometric validation process for some of these. A set of 23 questionnaires was developed through literature review and discussion with professionals from one Spanish tertiary hospital, and supplemented with Net Promoter Scores (NPS). The hospital piloted the questionnaires, receiving 400,719 responses (November-2022-November-2025). These were described for reference benchmarking. Questionnaire dashboards were enabled to all hospital professionals Intranet. Five of the PREMs underwent content validation:focus groups/interviews in the aforementioned hospital(July-2024-September-2025) and psychometric validation(June-2025-January-2026) involving 11 hospitals from 4 Spanish regions, including an item-bank proposal and scoring. A cultural adaptation process was performed into Catalan and English, involving additional hospitals. The hospital received 400,719 responses from 23 questionnaires (24% overall response-rate). The main average NPS values (range across services) were: adult patients hospitalization/adults referring to children's hospitalization (77ad/70adch;55-84), emergencies without hospitalization (71/52), external face-to-face consultations (83ad/75ch;38-83). Through five questionnaires tested with focus groups, items were nunaced, deleted or added. The questionnaires proved psychometrically robust. The process per questionnaire involved between 106-1,353 patients per validation wave. The cultural adaptation process was formally completed with minor changes. Fully-validated questionnaires are generated and detailed with data from several patient profiles and without specific units biases enabling wide patient experience analyses. The robust validated questionnaires can inspire other hospitals future value-based healthcare.