White paper lays out framework for identifying health disparities

A new evidence-based framework aims to establish a U.S. industry standard for measuring health equity efforts.

Put out by the Institute for Healthcare Improvement (IHI), the white paper has been in the works for two years. It offers a four-step approach to help healthcare teams across settings identify health disparities. Advancing health equity is defined in the paper as reducing and eliminating health disparities that adversely affect historically underserved groups.

“We’re hoping that this will be a standardized approach to data and measurement,” Nikki Tennermann, IHI senior project director and an author of the white paper, told Fierce Healthcare. “We wanted to make sure that this framework was accessible to big large integrated health systems but also maybe it’s a small local mental health alliance.”

In healthcare, there is no single standard to identify, quantify, track and report health equity gaps in patients, per the paper. The framework aims to address that. More than 35 subject-matter experts representing clinical, quality, payer, academic and administrative roles contributed to the framework.  

“We really are confident that we tried to get representative voices from all parts of healthcare, so the measurement framework is really resonant and applicable across settings,” Tennermann said.

The four recommended steps in the paper are: 

1. Identify and prioritize a health equity effort focus area, population of focus and metrics
2. Determine stratification attributes and calculate metrics for all attribute values
3. Choose reference points
4. Quantify and characterize health disparities 

The IHI Leadership Alliance, a group of 60 organizations across the U.S., formed a health equity accelerator in 2024 that produced the paper. “IHI is committed to advancing health equity. It’s core to what we do,” Tennerman said. Members of the leadership alliance look to IHI for guidance on the work, she added. “I see a lot of excitement at these recommendations, and appreciation for IHI putting out such an evidence-based and rigorous measurement framework.” 

“Equity is the foundation of high-quality health care. Without it, it’s nearly impossible for patients and communities to consistently get safe, reliable care,” Whitney Haggerson, vice president for health equity and Medicaid at Providence, told Fierce Healthcare in emailed comments. “This guidance equips us to uncover disparities with precision across quality, access and patient experience, easing the way for medical professionals to provide patients with high-quality, individualized care that everyone deserves.” 

There are numerous regulatory and legislative standards and mandates to advance health equity already. However, the lack of guidance on how to help organizations meet them is a problem, the paper argues. Regardless of external standards, organizations looking to improve quality should be motivated internally to reduce disparities, it said.

The paper also laid out the business case for health equity, including reducing healthcare costs, increasing value-based incentives and enabling workforce productivity. 

“Quantifying health equity gaps by measuring disparities is an essential first step in advancing quality and patient safety in health care,” the paper concluded. “Without standardized metrics, it is nearly impossible to identify the true scope and drivers of inequities, making targeted interventions less effective and perpetuating gaps in outcomes for marginalized populations.”