title: Reducing health disparities: strategy planning and implementation in Israel's largest health care organization.
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.
  
  
  METHODS
  Clalit Health Services, Israel's largest non-for-profit insurer and provider serving 3.8 million persons.
  
  
  METHODS
  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.
  
  
  METHODS
  Quality indicator scores, derived from Clalit's central data warehouse, based on data from electronic medical records.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel, Israel.
authors.forename: Ran D
authors.initials: RD
authors.lastname: Balicer
authors.forename: Efrat
authors.initials: E
authors.lastname: Shadmi
authors.forename: Nicky
authors.initials: N
authors.lastname: Lieberman
authors.forename: Sari
authors.initials: S
authors.lastname: Greenberg-Dotan
authors.forename: Margalit
authors.initials: M
authors.lastname: Goldfracht
authors.forename: Liora
authors.initials: L
authors.lastname: Jana
authors.forename: Arnon D
authors.initials: AD
authors.lastname: Cohen
authors.forename: Sigal
authors.initials: S
authors.lastname: Regev-Rosenberg
authors.forename: Orit
authors.initials: O
authors.lastname: Jacobson
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D006298:Health Services Administration / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000706:statistics & numerical data; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D008913:Minority Groups / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D012959:Socioeconomic Factors