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# Executive Summary
It has been more than 20 years since the National Academy of Medicine published their report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, and despite decades of efforts, true health equity remains a distant goal. The COVID-19 pandemic laid bare the equity gaps that plague health and health care today, and it tragically demonstrated the devastating impacts these gaps have on individuals and communities.
One of the core challenges in addressing inequities in health and care is measurement. The old saying, “What gets measured gets improved” may well be wrong, but it is indisputable that sustained improvement requires measurement. Yet, in the health care industry, there is no standard or consensus on best practices to identify, quantify, track, and report health equity gaps among patient populations. To help address this need, this document presents a detailed, four-step approach for identifying inequities and constructing metrics that advances health equity for health systems.
# Four-Step Approach to Systematically Evaluate Health Disparities:
- STEP 1: Identify and Prioritize a Health Equity Initiative Focus Area, Population of Focus, and Metrics
- STEP 2: Determine Stratification Attributes and Compute Metrics for all Attribute Values
- STEP 3: Choose Reference Points
- STEP 4: Quantify and Characterize Health Disparities
Based on the current, cumulative state of health equity measurement research and practice, this four-step approach represents the consensus of more than 35 subject-matter experts representing experience and expertise spanning a vast array of health care settings including clinical, quality, payor, academia, administration, and the relevant health care quality improvement and disparities reduction literature. This document is intended to be a practical guide to achieve a minimum set of agreed-upon practices for analyzing and reporting equity data – from which benchmarks can evolve. The goal is to provide guidance that is intentionally flexible to allow for local applicability.
This paper includes the following:
- The context of environmental factors such as current mandates and standards for health-equity measurement;
- Recommendations for creating a health care environment where everyone thrives;
- A detailed discussion of the four-step approach to systematically identify and evaluate health disparities;
- Examples of how to apply this approach in a variety of health care settings; and
- Additional considerations and resources for evaluating the significance of findings.