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PREMIERE

Background

Patient-Reported Experience Measures (PREMs) enable patients to describe their experiences of healthcare, including what was done well and what could be improved. Unlike measures of clinical outcomes, PREMs focus on how care is experienced by patients.

People receiving vascular surgery frequently have complex and long-term healthcare needs. Their care may involve emergency treatment, major surgery, limb-saving procedures, prolonged hospital stays and ongoing multidisciplinary support. Despite this complexity, no validated PREM had previously been developed specifically for vascular surgery.

The Patient-Reported Experience Measures in Vascular Surgery Enhancement (PREMIERE) Study was established to address this gap by developing a scientifically robust, patient-centred questionnaire for people receiving vascular surgical care.

Why is it important?

Clinical outcomes alone do not show whether patients felt informed, supported, involved in decisions or able to access care when needed.

The PREMIERE questionnaire gives vascular patients a voice and helps services identify good practice, areas for improvement and whether changes to care improve patients’ experiences. This supports the delivery of value-based, person-centred vascular care across the UK.

Aims

The original PREMIERE study aimed to develop and validate the first vascular-surgery-specific PREM.

Following the successful completion of this work, the programme is now progressing towards national implementation. The next phase will examine how the PREMIERE questionnaire can be integrated into routine vascular practice and used to support service improvement across the UK.

What has the study achieved?

The PREMIERE questionnaire was developed through a sequential mixed-methods programme involving patients, carers and healthcare professionals across Wales.

The programme included:

  • a systematic review of PREMs used in surgical care;
  • interviews and focus groups exploring the experiences of vascular surgery patients;
  • focus groups with healthcare professionals from different disciplines;
  • large-scale psychometric validation across all three vascular networks in Wales.

A total of 240 vascular surgery patients participated in the validation study. Psychometric analysis and item reduction refined the questionnaire from 22 items to a final 14-item questionnaire covering five key domains of patient experience.

The final questionnaire takes approximately seven minutes to complete, and more than 82% of participants were able to complete it independently. Testing demonstrated acceptable reliability, validity and feasibility for use across a diverse vascular surgery population.

The completed PREMIERE questionnaire is the first validated patient-reported experience measure developed specifically for vascular surgery.

Next phase: National Implementation

The next phase of PREMIERE has secured funding through the National Institute for Health and Care Research (NIHR) Research for Patient Benefit programme (RfPB).

Scheduled to begin in November 2026, this phase will evaluate the implementation of the PREMIERE questionnaire across approximately 15–20 vascular units in the UK. It will examine:

  • the feasibility of incorporating PREMIERE into routine clinical pathways;
  • questionnaire uptake and completion;
  • accessibility across different patient populations;
  • acceptability to patients and healthcare professionals;
  • how vascular teams interpret and use the findings; and
  • whether the results can support measurable improvements in care.

The longer-term ambition is to establish a sustainable national approach to measuring patient experience in vascular surgery and to support integration with national audit, registry and quality-improvement programmes.

Patient and public involvement

Patient and public involvement has been central to PREMIERE from its inception.

Patient representatives helped shape the original research question, study design, participant materials, questionnaire content and interpretation of the findings. Patients with lived experience of vascular disease and treatment have been members of the research and steering groups throughout the programme.

The questionnaire itself was developed directly from the experiences and priorities described by vascular patients. Participants were recruited from geographically and clinically diverse populations across Wales to ensure that the measure reflected a broad range of experiences.

Patient partners will continue to play a central role during the national implementation phase, including advising on accessibility, recruitment, interpretation, dissemination and service improvement.

Dissemination and impact

Findings from the PREMIERE programme have been published in peer-reviewed journals and presented at national and international vascular and health-services research conferences.

In recognition of its progression from patient insight to meaningful healthcare impact, PREMIERE has been shortlisted as a finalist in the “From Insight to Impact” category at the 2026 Picker Experience Network (PEN) Awards.

Outputs from the programme include:

  • a systematic review of patient-reported experience measures in surgical care;
  • a qualitative study exploring patients’ experiences of vascular surgery;
  • research examining healthcare professionals’ perspectives on challenges within vascular services;
  • a published protocol describing the development and validation programme; and
  • publication of the UK validation of the final PREMIERE questionnaire.

The programme has also engaged with patients, vascular professionals, research networks, healthcare organisations and national quality-improvement partners. Future dissemination will include peer-reviewed publications, conference presentations, patient-facing materials, infographics, professional networks and digital platforms.

Study details

  • Short title: PREMIERE
  • Full title: Patient-Reported Experience Measures in Vascular Surgery Enhancement Study
  • Original study design: Sequential mixed-methods development and psychometric validation study
  • Study population: Adult patients receiving vascular surgical care across the three vascular networks in Wales
  • Validation sample: 240 patients
  • Final questionnaire: 14 items across five domains
  • Co-Chief Investigators: Professor David Bosanquet and Dr Kathleen Withers
  • Research Fellow: Miss Maram Darwish
  • Original sponsor: Cardiff and Vale University Health Board
  • Original funding: Welsh Value in Health Centre
  • Research Ethics Committee reference: 24/PR/0522
  • IRAS project ID: 343073
  • Trial registration: NCT06363175
  • National implementation funding: NIHR Research for Patient Benefit programme
  • NIHR award reference: NIHR512604
  • National implementation host and sponsor: Nottingham University Hospitals NHS Trust
  • Planned national implementation start: November 2026

Key publications