title: Reducing inequity in primary care clinics treating low socioeconomic Jewish and Arab populations in Israel.
abstract: An organization-wide inequity-reduction quality improvement (QI) initiative was implemented in primary care clinics serving disadvantaged Arab and Jewish populations. Using the Chronic Care Model (CCM), this study investigated the types of interventions associated with success in inequity reduction.
  
  
  
  Semi-structured interviews were conducted with 80 staff members from 26 target clinics, and information about intervention types was coded by CCM and clinical domains (e.g. diabetes, hypertension and lipid control; performance of mammography tests). Relationships between type and number of interventions implemented and inequity reduction were assessed.
  
  
  
  Target clinics implemented 454 different interventions, on average 17.5 interventions per clinic. Interventions focused on Decision support and Community linkages were positively correlated with improvement in the composite quality score (P < 0.05). Conversely, focusing on a specific clinical domain was not correlated with a higher quality score.
  
  
  
  Focusing on training team members in selected QI topics and/or tailoring interventions to meet community needs was key to the interventions' success. Such findings, especially in light of the lack of association between QI and a focus on a specific clinical domain, support other calls for adopting a systems approach to achieving wide-scale inequity reduction.
authors.affiliation: Faculty of Social Welfare and Health Sciences, University of Haifa, Room 2104 Eshkol Tower, 99 Aba Khoushy Ave., Mount Carmel 31905, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Spitzer-Shohat
authors.affiliation: Faculty of Social Welfare and Health Sciences, University of Haifa, Room 2104 Eshkol Tower, 99 Aba Khoushy Ave., Mount Carmel 31905, Israel.|Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Shadmi
authors.affiliation: Clalit Community Division, Clalit Health Services, 101 Arlozorov St., Tel Aviv, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Goldfracht
authors.affiliation: Clalit Community Division, Clalit Health Services, 101 Arlozorov St., Tel Aviv, Israel.
authors.forename: C
authors.initials: C
authors.lastname: Kay
authors.affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Hoshen
authors.affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel.|Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
authors.forename: R D
authors.initials: RD
authors.lastname: Balicer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D018912:Arabs / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D007585:Jews / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
keywords: chronic disease; inequity; primary care; quality improvement