276 Chapter 9 PROMIS common metric Another advantage of the use of PROMIS (item response theory) is the standardization of the scoring system, also referred to as the common metric (74). The common metric makes it possible to compare scores of different PROMIS measures and allows for the addition of new items to the existing measures (74-76). This makes PROMIS flexible and sustainable for the future (74). In addition, the common metric can contribute to PCC as it makes it possible to adapt items to different patient populations (for example for patients with low health literacy or reduced language proficiency). More research is needed in this field with regard to the content (i.e., to examine to what extent it is necessary to modify items for different patient populations) and statistical aspects (i.e., the replacement of items). Part 3: Patient Reported Experience Measures An important incentive for the use of PREMs is that it provides data that can be used for quality improvement (43). However, our experience is that the use of PREMS is difficult in clinical practice. There is a lot of uncertainty about how PREM data can be used meaningfully for quality improvement. Studies showed that lack of guidance hinders the application of PREMs to improve the quality of health care services (43). Other challenges in using PREMs include lack of time and resources for both the administration of PREMs as analyzing the data, variation in the use of PREMs, and lack of skills among clinicians, policymakers, and researchers to use and interpret PREM data (43, 77). Future research should focus on how PREM data can contribute to quality improvement to provide PCC. Lessons learned can be shared and merged to a guideline for the use of PREMs. Initiatives, such as the PREM working group from Linnean (www.linnean.nl), can contribute to this purpose (78). However, more indepth conversations and profound collaboration on this important topic is necessary to make the use of PREMs in health care a success. Conclusion The importance of patient-centered care is recognized, but its application is still in its infancy. The shift towards patient-centered care is difficult as it requires a shift in thinking and a redefinition of roles and decision-making for patients, parents, clinicians, policymakers and researchers. This thesis contributes towards this goal as it provides scientific information and shared lessons for clinicians and tools to empower both patients and clinicians in their new roles.
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