How are PQI’s identified?
A potential quality issue is a suspected deviation from provider performance, clinical care, or outcome of care which requires further investigation to determine if an actual quality of care concern or opportunity for improvement exists. PHC identifies PQIs through the systematic review of a variety of data sources, including but not limited to:
- Complaints, grievances, and appeals
- Claims and encounter data
- Care coordination
- Medical record audits
- Referrals from other health plan staff, providers, and members of the community
What happens when a quality issue is identified?
When should a PQI be referred?
Any time there is a suspected quality of care concern; some examples may include:
How can a PQI be referred?
Contact us for additional information.
Southern Region: (707) 863-4620