Summary
- A new four-step IHI framework aims to standardize health equity measurement and guide work to analyze health equity quality data.
The IHI Health Equity Accelerator, a group of 19 diverse health care organizations from across the US and convened through the IHI Leadership Alliance, was hard at work in 2024 and 2025 with a clear aim: to define evidence-based best practices for measuring and identifying health disparities. The leaders conducted a national survey of health care organizations, interviewed executive leaders, and hosted a consensus-building workshop.
Participating members synthesized their learnings and published a white paper detailing a new health equity measurement framework, “Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities.” A four-step approach was rigorously developed, is evidence-based, and aims to support health care organizations as they examine their quality and performance data.
The framework includes the following steps to identify disparities in patient populations:
- Identify and Prioritize a Health Equity Initiative Focus Area, Population of Focus, and Metrics
- Determine Stratification Attributes and Compute Metrics for All Attribute Values
- Choose Reference Points
- Quantify and Characterize Health Disparities
This framework is an important first step toward standardizing health equity measurement, enabling health care organizations to systematically identify, quantify, and report disparities. This fosters greater accountability within organizations and better aligns health equity efforts nationwide.
According to Kristen Azar, IHI Faculty and IHI Health Equity Accelerator Advisor, “Without a standard approach to measuring health disparities, health care systems and organizations are left with fragmented data that obscure the very inequities we seek to eliminate. A consistent framework will allow us to compare performance, identify gaps, and hold ourselves accountable across the industry — ensuring that equity is not an aspiration but a measurable outcome.”
Going beyond just theory, the white paper reviews practical applications of the measurement framework. One example for applying the four-step measurement approach focuses on a health care organization that has identified hypertension and blood pressure control as a strategic quality improvement priority. The framework demonstrates how to identify the sources of blood pressure data that an organization has access to and how to define the patient population, including how to include any patients with hypertension who are missing from care. It highlights how to select sociodemographic variables for stratification and, most significantly, how to compute and quantify differences across demographic groups with hypertension. This tangible example enables health care leaders and data analysts who are examining health disparities to see how to use the measurement framework in a real-world setting.
Health care organizations from across the industry, including health plans, federally qualified health centers, independent practices, and large integrated health systems, are encouraged to test the measurement framework. We can’t improve what we don’t measure, so advancing health equity relies on our collective efforts to use data to identify health disparities. We believe this four-step framework is the first step to creating a standard in health care for measuring health disparities.
Learn More at the IHI Forum
If you’re curious about how to implement the framework, or have questions about how to apply this framework in your care setting or organization, join the IHI Forum 2025 session “D17: Turning Insight into Action: Standardizing How We Identify, Measure, and Address Health Disparities.” This session is part of the Health Equity track and is appropriate for general audiences.
Kristen MJ Azar, PhD, RN, MSN/MPH, is a member of IHI’s faculty and the VP of Quality and Performance Excellence at the Institute on Aging.
Nikki Tennermann, LICSW, MBA, is a Senior Project Director at the Institute for Healthcare Improvement.
Photo by Fleur
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