Validation of a COPD Patient-Reported Experience Measure (PREM-C9) in Ontario, Canada

Elaine Zibrowski, School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario CanadaFollow
Floriana Islami, Health Promotion, Health and Rehabilitation Sciences, Western University, London, Ontario, CanadaFollow
Alyson Kellar, Asthma Research Group Windsor-Essex County Inc., Windsor, Ontario, CanadaFollow
Christopher Licskai, Asthma Research Group Windsor-Essex County Inc., Windsor, Ontario, Canada, Schulich School of Medicine & Dentistry, Department of Medicine, Division of Respirology, Western University, London, Ontario Canada; AND London Health Sciences Centre, London, Ontario, Canada Follow
Madonna Ferrone, Asthma Research Group Windsor-Essex County Inc., Windsor, Ontario, CanadaFollow
Shannon L. Sibbald, School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario Canada AND Schulich School of Medicine & Dentistry, Department of Family Medicine, Western University, London, Ontario Canada

ORCID

Elaine Zibrowski: https://orcid.org/0000-0002-5653-3303

Floriana Islami: https://orcid.org/0009-0006-3810-6400

Alyson Kellar: https://orcid.org/0009-0002-5832-1619

Christopher Licskai: https://orcid.org/0000-0002-1675-657X

Madonna Ferrone: https://orcid.org/0000-0003-3698-1384

Abstract

Objective: Patient-reported experience measures (PREM) are important tools for evaluating healthcare quality, yet their implementation in chronic obstructive pulmonary disease (COPD) care within Canada remains limited. Our objective was to examine the construct validity of the PREM-C9 instrument in a Canadian context and explore its potential clinical applications beyond measuring patient experience. Methods: A two-phase, prospective, cross-sectional, mixed-methods study was conducted across 41 Best Care COPD sites in Ontario, Canada. In the quantitative phase, confirmatory factor analysis assessed the construct validity of the PREM-C9. In the qualitative phase, focus group interviews with COPD case managers explored implementation experiences and perceived clinical utility. Data collection occurred from November 2023 to February 2024. Results: Confirmatory factor analysis supported the three-factor structure of the PREM-C9 with good internal consistency reliability (McDonald's Omega and Cronbach's alpha). The instrument demonstrated validity in the Canadian context with significant correlation between global healthcare ratings and total PREM scores. Case managers reported favorable perceptions of the assessment and described using patient responses to guide care actions, suggesting potential as a clinical conversation tool beyond its original purpose as an experience measure. Conclusion: The PREM-C9 demonstrates construct validity within Canadian COPD care settings. Our adaptations, including terminology changes reflecting Canadian healthcare context and addition of a global healthcare rating item, enhanced its relevance. Further refinements addressing implementation challenges and scaling presentation could improve usability. The instrument shows promise as both a quality measurement tool and a communication aid that facilitates personalized care planning in integrated COPD management programs.

Recommended Citation

Zibrowski E, Islami F, Kellar A, Licskai C, Ferrone M, Sibbald S. Validation of a COPD Patient-Reported Experience Measure (PREM-C9) in Ontario, Canada. Patient Experience Journal. 2026; 13(1):218-228. doi: 10.35680/2372-0247.2108.