The CQI program may include the establishment of credentialing standards, regular review of practice patterns, study of clinical outcomes, routine utilization review and case management. These may be mandated by third party payors or developed by health care delivery group. A comprehensive set of health services ranging from preventive and ambulatory services to acute care to long-term and rehabilitative services. Continuum of care involves coordinating the mix of services that each patient may require.
Primary care tends to be the point of access for most patients.
If the patient is well, then the health system would ideally place that person along a track geared toward promoting and maintaining wellness. If the patient has one or more chronic illnesses, then the system would ideally enlist tools and techniques to manage those conditions across sites and providers of care. Such a system provides consistency and continuity of care, while encouraging patients toward responsibility for improving or maintaining their health, independence and well-being. He or she decides on what tests to order, when consultation and hospitalization is needed and whether or not to carry out consultant s recommendations. In the original gatekeeper systems used by HMOs and many PPOs, the patient cannot self-refer to specialists.