215 Systematic review PREMs Discussion In this review, we document the geographic distribution of pediatric PREMs used and quantify the different PREMs administered in clinical care. PREMs are often falsely synonymized with patient reported outcome measures (PROMs) and satisfaction questionnaires, but these three types of questionnaires have distinct purposes and target different elements of patient care. In contrast to PROMs, which assess the patient’s health status and measures quality of life, PREMs focus on care processes and their perceived impact on overall patient experience [52]. While dissimilar in outlook, PREMs and PROMs are often used in tandem to gather information related to the patient’s care experience and outcome contentment. The terms patient satisfaction and patient experience despite being often used interchangeably, are different. Patient experience assesses whether something that should happen in a healthcare setting (such as clear communication with a provider) actually happened or how often it happened. On the other hand, satisfaction is about whether a patient’s expectations about a health encounter were met [52-54] .PREMs also differ from patient satisfaction surveys, which relate to patient expectations and often involve a degree of subjectivity that is not seen in PREMs [52,55-57]. The results of our review demonstrate an international uptake of pediatric PREMs in clinical care, totaling 49 different PREMs, 39 from peer-reviewed articles and 10 from gray literature that were used in 14 developed countries spanning four continents. While administered in 14 different countries, the development of these PREMs only occurred in seven, with the greatest heterogeneity in both pediatric PREM development and implementation occurring in the United States (21), followed by the United Kingdom (9). While primarily utilized for quality improvement purposes, various research groups implemented pediatric PREMs to gauge how the responses varied between patient populations or between the patients and their family caregivers. Measuring patient and family experience has a critical role in informing PFCC. Previous studies have explored the development and psychometric evaluation of PREMs, assessed their validity and reliability, and compared different PREM instruments for their respective utilization [58-60]. Studies have also noted differences between proxy ratings, usually coming from a family caregiver, and the ratings of a patient themselves, where the patient tends to provide lower rating regarding their own experiences of care [49,61]. Additionally, there exists a paucity of information regarding the use of pediatric PREMs, and their type (i.e., generic, 8
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