Health Disparities

Health disparities reduction strategy through targeted quality improvement


The implementation and evaluation of a quality improvement-based targeted disparity reduction strategy that significantly reduced health disparities in a wide range of clinical domains among disadvantaged populations.

Context and Aims

Reducing racial and ethnic disparities in health and health care has been a long-standing goal of health care systems worldwide; however, it has yet to be demonstrated if interventions can sustain positive results for a broad array of health conditions. The objectives of this project were to implement and assess an organization-wide quality improvement (QI) disparity reduction intervention and its sustainability over three years.

Research Approach

This study focused on the implementation and evaluation of a strategy that incorporated targeted disparity reduction into quality improvement efforts. The strategy entailed locally tailored disparity reduction interventions implemented within a QI framework to reduce health disparities while improving the quality of care among disadvantaged populations.

The disparity reduction intervention included complementary top-down and bottom-up components. The top-down approach encompassed quality target setting and monitoring, the provision of supportive health information technology tools, and the direct involvement of the chief executive officer. The bottom-up approach incorporated clinic-specific policy changes, intra-organizational professional training in teamwork and specific clinical areas, and culturally tailored interventions according to the specific needs of the local population.


Health disparities graph

Key Findings and/or Potential Impact

The 36-month disparity-reduction efforts yielded scalable improvement in health outcomes and process measures, a narrowed health disparity gap (about two-thirds) from the pre-intervention period, and sustainable results that were measured one year post-intervention.

Quality improvement can achieve significant reduction in disparities in a wide range of clinical domains, which can be sustained over time.




Spitzer-Shohat S, Shadmi E, Goldfracht M, Kay C, Hoshen M, Balicer RD. Reducing inequity in primary care clinics treating low socioeconomic Jewish and Arab populations in Israel. Journal of Public Health (Oxford, England), 2016. (Epub ahead of print)

Balicer RD, Hoshen M, Cohen-Stavi C, Shohat-Spitzer S, Kay C, Bitterman H, Lieberman N, Jacobson O, Shadmi E. Sustained Reduction in Health Disparities Achieved through Targeted Quality Improvement: One-Year Follow-up on a Three-Year Intervention. Health Services Research, 2015. 50(6): p. 1891-909.

Balicer RD, Shadmi E, Lieberman N, Greenberg-Dotan S, Goldfracht M, Jana L, Cohen AD, Regev-Rosenberg S, and Jacobson O. Reducing Health Disparities: Strategy Planning and Implementation in Israel’s Largest Health Care Organization. Health Services Research, 2011. 46(4): p. 1281–99.