Reducing health disparities: strategy planning and implementation in Israel's largest health care organization

To describe an organization-wide disparity reduction strategy and to assess its success in quality improvement and reduction of gaps in health and health care.

Clalit Health Services, Israel's largest non-for-profit insurer and provider serving 3.8 million persons.

Before and after design: quality assessment before and 12-month postinitiation of the strategic plan. A composite weighted score of seven quality indicators, measuring attainment of diabetes, blood pressure, and lipid control, lack of anemia in infants, and performance of mammography, occult blood tests, and influenza vaccinations.

Quality indicator scores, derived from Clalit's central data warehouse, based on data from electronic medical records.

Low-performing clinics, of low-socioeconomic and minority populations, were targeted for intervention. Twelve months after the initiation of the project continuous improvement was observed coupled with a reduction of 40 percent of the gap between disadvantaged clinics, serving ~10 percent of enrollees, and all other medium-large clinics.

The comprehensive strategy, following a quality improvement framework, with a top-down top-management incentives and monitoring, and a bottom-up locally tailored interventions, approach, is showing promising results of overall quality improvement coupled with disparity reduction in key health and health care indicators.