If patient-reported outcome measures are considered key health-care quality indicators, who is excluded from participation?

Patient-reported outcome measures have received increasing attentionwith regard to ensuring quality improvement across the healthservice. However, there is a risk that people with disabilities and lowliteracy are systematically excluded from the development of thesemeasures as well as their application in clinical practice. Thiseditorial highlights some of these risks and the potential consequencesof exclusion for these groups