Do primary care quality improvement frameworks consider equity?

Area of Science:

• Healthcare Quality Improvement
• Health Equity
• Primary Care Research

Background:

• Quality improvement (QI) initiatives are globally implemented in healthcare to enhance patient care.
• However, without explicit attention to equity, QI projects risk widening health disparities for vulnerable populations.
• The extent to which primary care QI frameworks incorporate equity considerations remains largely unknown.

Purpose of the Study:

• To investigate the consideration of health equity within primary care quality improvement frameworks.
• To assess whether existing QI frameworks adequately address potential exacerbation of health inequalities.

Main Methods:

• A comprehensive search of MEDLINE, EMBASE, and relevant websites identified primary care QI frameworks.
• An expert panel refined the framework list.
• Guidance documents for selected frameworks underwent thematic analysis using NVivo.

Main Results:

• Analysis of 15 QI guidance documents revealed limited explicit discussion of equity or targeted interventions for disadvantaged groups.
• Inequalities were indirectly addressed through patient involvement strategies and demographic targeting.
• A predominant focus on efficiency over equity was observed in the analyzed documents.

Conclusions:

• Primary care QI frameworks demonstrate insufficient consideration of health equity.
• When equity is mentioned, it is often implicit and subject to varied interpretation.
• Frameworks require explicit revision to prioritize equity, ensuring fair distribution of QI benefits across all patient groups.