# Moving forward, leaving the patients behind? A multilevel assessment framework for evaluating patient-centred, integrated care quality

## TL;DR

This study highlights a gap between healthcare evaluation practices and patient priorities, proposing a new framework to better align care quality assessments with patient-defined outcomes.

## Contribution

The paper introduces Patient-Reported Integrated Measures (PRIMs) as a novel conceptual framework for patient-centred care evaluation.

## Key findings

- Current evaluation practices often neglect patient-defined outcomes, especially for those with complex health needs.
- Patient perspectives are rarely integrated into evaluation criteria, creating a disconnect between policy and individual well-being.
- PRIMs can help align care evaluation with patient priorities by capturing multidimensional outcomes.

## Abstract

Many current care assessment frameworks prioritise clinical and organisational outcomes over patient perspectives. This study aimed to identify gaps in existing patient-centred assessment methods and to develop a multilevel framework aligning quality evaluation with patient-defined priorities across macro (policy), meso (organisational), and micro (individual) levels, and technological levels.

We used a primarily qualitative design, conducting a literature review of patient-centred integrated care assessment studies and integrating these findings with a longitudinal case study that examined how the patient’s perspectives were documented across multiple health information systems, synthesising evidence on existing practices with insights into how patient perspectives are integrated and represented for a comprehensive understanding.

In total, 32 studies were included. The review revealed ongoing misalignment between systemic evaluation practices and patient-defined outcomes, particularly for individuals with complex physical and mental health needs. Minimal patient involvement in developing evaluation criteria reflected a disconnect between policy-level targets and individual patient well-being. This misalignment was echoed in the case study, which underscored that personal goals and non-clinical needs were often unrecorded, highlighting the gap between evaluation metrics and genuinely patient-centred care.

Integrated care quality assessment remains misaligned with patient-defined outcomes. We propose Patient-Reported Integrated Measures (PRIMs) as a conceptual contribution. PRIMs complement existing Patient-Reported Outcome Measures (PROM) and Patient-Reported Experience Measures (PREM) by capturing multidimensional outcomes that matter to patients and ensuring evaluation aligns with their goals. Integrating PRIMs into health information systems and research agendas can realign care evaluation with evolving patient priorities, thereby reducing the risk of leaving patients behind in future healthcare reforms.