Learning From Statewide Collaborative Quality Initiatives to Advance Equitable Care

While health-care quality improvement (QI) initiatives have improved health outcomes, these benefits are not accessible to all patients. Currently, there is no clear roadmap for implementing QI to address health inequities. Therefore, we studied the experiences of collaborative quality improvement (CQI) leaders who leverage QI to address health inequities.

We conducted semi-structured group and individual interviews with 25 leaders from 12 CQI coordinating centers in Michigan between May and August 2025. Participants were asked about their current QI initiatives that seek to explore or mitigate the impact of nonmedical drivers of health outcome variability. Interviews were audio-recorded, transcribed verbatim, and deidentified. Data were analyzed using a combination of deductive and inductive content analysis, followed by a secondary matrix analysis.

Participants identified challenges and opportunities in conducting QI to evaluate gaps and ensure access to quality care across three major themes. First, data points and variables that assess nonmedical drivers of care were often missing or lacked standardization. Second, CQIs and hospitals had an inconsistent understanding of health equity. Lastly, patients and hospitals had variable access to resources that could help to address gaps in access and improve quality.

In this study, CQI leaders identified common challenges that affect their ability to ensure that their QI efforts are accessible and effective for all patients. By collaboratively learning from these challenges and sharing the paths they identified to move forward, there is greater potential to ensure that QI can provide access to high-quality care for all individuals.