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Potential Quality Issue

A potential quality issue (PQI) is a suspected deviation from provider or practitioner performance, clinical care, or outcome of care which requires further investigation to determine if an actual Quality of Care (QOC) concern exists.

CenCal Health maintains a mechanism to identify, analyze, and resolve PQIs to ensure that services provided to CCH members meet established QOC and service standards. Investigation is thoroughly performed by clinically licensed staff subsequent to the identification of a PQI to reveal whether care was substandard or rendered in accordance with prevailing clinical standards. The Medical Director determines if there are opportunities for improvement in the provision of care and services to CCH members, and directs appropriate actions for improvement based upon outcome, risk, frequency and severity.

PQIs may be reported by any of the following:

  • CenCal Health staff member
  • Anonymous
  • Any member of the community
  • Any contracted or non-contracted provider / staff

A PQI is reported to the Quality Improvement (QI) department by sending a completed PQI Referral Form (RF), to Click here to access the PQI form.

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