Implementation of an Integrated PREMs-PROMs Survey in Saudi Arabia: A Cross-Sectional Pilot Study

PROMs capture health-related quality of life from the patient's perspective, while PREMs assess how patients experience care delivery. Although each measure provides distinct insights, their integration into a single survey offers a more comprehensive view of care quality, enabling healthcare systems to understand not only what outcomes patients achieve, but how they experience receiving care. Despite growing international momentum for combined PREMs-PROMs measurement, their integrated use has not been systematically assessed in Saudi Arabia. This pilot study evaluated the feasibility and psychometric properties of two internationally validated PROMs tools, EQ-5D-5L and PROMIS-10 Global Health, when administered within an existing nationally implemented PREMs survey among adult outpatients across 15 hospitals (n = 450). Surveys were distributed via SMS in three waves to examine potential effects of survey order and length. Known-groups and convergent validity were assessed using the Kruskal-Wallis and Mann-Whitney U tests. Both instruments demonstrated strong validity, with statistically significant differences observed across levels of symptom severity (p < 0.001). PROMIS Physical Health showed greater sensitivity to chronic disease burden, whereas EQ-5D-5L provided broader coverage of health domains. Response rates remained strong when PROMs were added to PREMs, consistent with ranges reported in comparable international surveys. As the first study in Saudi Arabia to evaluate integrated PREMs-PROMs measurement in routine outpatient care, these findings provide operational and psychometric evidence to inform the Kingdom's value-based healthcare initiatives.