Reducing inequity in primary care clinics treating low socioeconomic Jewish and Arab populations in Israel

S. Spitzer-Shohat, E. Shadmi, M. Goldfracht, C. Kay, M. Hoshen, R. D. Balicer

Research output: Contribution to journalArticlepeer-review


Background 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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish
Pages (from-to)395-402
Number of pages8
JournalJournal of Public Health
Issue number2
StatePublished - 1 Jun 2017

Bibliographical note

Publisher Copyright:
© The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.


  • chronic disease
  • inequity
  • primary care
  • quality improvement

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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