Reducing Health Disparities: Strategy Planning and Implementation in Israel's Largest Health Care Organization

Authors

  • Ran D. Balicer,

    1. Clalit Health Services, Tel Aviv, Israel. Ran D
    2. Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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  • Efrat Shadmi,

    1. Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel
    2. Clalit Health Services, Tel Aviv, Israel. Ran D
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    • Address correspondence to Efrat Shadmi, Ph.D., Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel; e-mail: eshadmi@univ.haifa.ac.il. Efrat Shadmi, Ph.D., Ran D. Balicer, M.D., M.P.H., Ph.D., Sari Greenberg-Dotan, Ph.D., Liora Jana, M.B.A., and Arnon D. Cohen, M.D., M.P.H., Ph.D., are with the Chief Physician Office, Clalit Health Services, Tel Aviv, Israel. Ran D. Balicer, M.D., M.P.H., Ph.D., is with the Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Nicky Lieberman, M.D., Margalit Goldfracht, M.D., and Orit Jacobson, Ph.D., are with the Community Health Division, Clalit Health Services, Tel-Aviv, Israel. Sari Greenberg-Dotan, Ph.D., is with the Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel. Arnon D. Cohen, M.D., M.P.H., Ph.D., is with the Division of Community Health, Sial Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel. Sigal Regev-Rosenberg, M.A., is with the Meir Medical Center, Clalit Health Services, Tel Aviv, Israel.

  • Nicky Lieberman,

    1. Community Health Division, Clalit Health Services, Tel-Aviv, Israel
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  • Sari Greenberg-Dotan,

    1. Clalit Health Services, Tel Aviv, Israel. Ran D
    2. Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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  • Margalit Goldfracht,

    1. Community Health Division, Clalit Health Services, Tel-Aviv, Israel
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  • Liora Jana,

    1. Clalit Health Services, Tel Aviv, Israel. Ran D
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  • Arnon D. Cohen,

    1. Clalit Health Services, Tel Aviv, Israel. Ran D
    2. Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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  • Sigal Regev-Rosenberg,

    1. Clalit Health Services, Tel Aviv, Israel. Ran D
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  • Orit Jacobson

    1. Community Health Division, Clalit Health Services, Tel-Aviv, Israel
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Abstract

Objective. 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.

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

Study Design. 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.

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

Principal Findings. 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.

Conclusion. 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.

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