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Objective. To assess a quality improvement disparity reduction intervention and its sustainability. Data Sources/Study Setting. Electronic health records and Quality Index database of Clalit Health Services in Israel (2008-2012). Study Design. Interrupted time-series with pre-, during, and postintervention disparities measurement between 55 target clinics (serving approximately 400,000 mostly low socioeconomic, minority populations) and all other (126) clinics. Data Collection/Extraction Methods. Data on a Quality Indicator Disparity Scale +(QUIDS-7) of 7 indicators, and on a 61-indicator scale (QUIDS-61). Principal Findings. The gap between intervention and nonintervention climes for QUIDS-7 decreased by 66.7 percent and by 70.4 percent for QUIDS-61. Disparity reduction continued (18.2 percent) during the follow-up period. Conclusions. Quality improvement can achieve significant reduction in disparities in a wide range of clinical domains, which can be sustained over time. Key Words. Health disparities, intervention, quality improvement, Eliminating disparities in health and health care has been a long-standing goal of health care systems worldwide (Marmot et al. 2010). A promising approach that has been suggested for reducing [...]

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 post-initiation 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. Key Words. Disparities, quality improvement, quality assessment, primary care, The role of health care organizations in reducing inequalities in health has recently drawn considerable interest from researchers and policy makers (McKee 2002; Smedley, Stith, and Nelson 2003). It is [...]

A study to examine the relationship between, community-dwelling older individuals' morbidity levels and the quality of their primary health care, is discussed.

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Readmission prevention should begin as early as possible during the index admission. Early identification may help target patients for within-hospital readmission prevention interventions.