IHI Unveils Groundbreaking Framework to Standardize Measurement of Health Equity Efforts Across U.S. Health Care
In a landmark move aimed at transforming how health care organizations address systemic inequities, the Institute for Healthcare Improvement (IHI) has released a comprehensive, evidence-based framework designed to establish a national standard for measuring health equity initiatives. Detailed in a newly published white paper titled “Advancing Health Equity: An Approach to Systematically Identify and Evaluate Health Disparities,” the framework offers a practical, four-step methodology that empowers health systems to detect, quantify, and ultimately reduce disparities in care delivery.
This initiative arrives at a critical juncture in U.S. health care, as regulatory bodies, payers, and the public increasingly demand transparency and accountability in equity performance. Developed through a collaborative effort involving leaders from a wide array of health care organizations, the framework represents the first standardized process of its kind—providing actionable guidance that moves beyond aspiration to measurable impact.
“At IHI, we often say, ‘measure what matters,’” said Sylvia Trent-Adams, PhD, RN, President and CEO of IHI. “This framework provides a first-of-its-kind process for health care organizations to identify inequities in their patient populations and systematically measure their efforts to reduce them. We strongly encourage health systems nationwide to adopt this approach as a catalyst for transformational change in understanding and eliminating health disparities.”
The development of the framework was spearheaded by the IHI Leadership Alliance’s Health Equity Accelerator—a coalition formed in 2024 comprising 19 leading health care organizations committed to advancing equity through shared learning and innovation. Recognizing the growing complexity of equity-related reporting requirements—from federal mandates to state-level policies and private payer expectations—the Accelerator identified a pressing need for a unified, evidence-based methodology to identify, track, and report disparities consistently across the health care ecosystem.
Until now, many organizations have struggled with fragmented data systems, inconsistent definitions of equity metrics, and a lack of clear guidance on how to stratify data meaningfully. This has often resulted in well-intentioned but siloed efforts that fail to produce scalable or comparable outcomes. The IHI framework directly addresses these challenges by offering a structured, replicable process grounded in quality improvement science and health equity principles.
A Four-Step Roadmap to Actionable Equity Insights
At the heart of the white paper is a clear, four-step approach that guides organizations through the process of identifying a health equity focus area and analyzing quantitative data to uncover disparities:
- Identify and Prioritize a Health Equity Initiative Focus Area, Population of Focus, and Metrics
Organizations begin by selecting a specific clinical or operational area where disparities are suspected or known to exist—such as maternal mortality, diabetes management, or access to behavioral health services. They then define the population of focus (e.g., Black women, rural communities, non-English speakers) and choose relevant, evidence-based quality or outcome metrics tied to that area. - Determine Stratification Attributes and Compute Metrics for All Attribute Values
Next, teams identify stratification variables—such as race, ethnicity, language preference, sexual orientation, gender identity, socioeconomic status, or geographic location—that may reveal inequities. The framework emphasizes the importance of collecting high-quality, self-reported demographic data and computing the selected metrics across all strata to enable meaningful comparisons. - Choose Reference Points
To contextualize findings, organizations select appropriate reference groups or benchmarks. This could be the highest-performing subgroup within their own data, national averages, or aspirational targets. Establishing a reference point allows teams to quantify the magnitude of disparities and prioritize interventions accordingly. - Quantify and Characterize Health Disparities
Finally, the framework guides users in calculating disparity measures—such as absolute differences, relative ratios, or disparity indices—and interpreting what these numbers mean in real-world terms. This step transforms raw data into actionable insights, helping leaders understand not just if disparities exist, but how large they are and which populations are most affected.
From Data to Transformation
The ultimate goal of the framework is not merely measurement for its own sake, but to drive equitable improvements in care. “Health care teams genuinely want to deliver the best possible care to every patient,” said Scott Cook, PhD, Co-Director of the Advancing Health Equity: Leading Care, Payment, and Systems Transformation program at the University of Chicago and a key advisor to the Health Equity Accelerator. “This new resource equips organizations with the tools to ensure their staff have the right data—not just to see inequities, but to act on them. It’s about turning insights into better care, reduced suffering, and saved lives. That’s how we make health care better for all of us.”
The white paper goes beyond theory, offering real-world case examples that illustrate how the four-step approach can be applied across diverse settings—including hospitals, community health centers, integrated delivery systems, and accountable care organizations. These practical applications demonstrate how the framework can be tailored to different contexts while maintaining methodological rigor.
Building a Foundation for National Accountability
By standardizing how disparities are measured, the IHI framework lays the groundwork for national benchmarking and cross-institutional learning. “Standardizing the measurement of disparities is imperative for driving accountability to health equity by identifying gaps in care,” emphasized Nikki Tennermann, IHI Senior Project Director and co-author of the white paper. “This clear and accessible guidance will help health care organizations move from fragmented data to measurable outcomes—enabling them to track progress over time and compare performance with peers.”
The framework is designed for broad usability, targeting health care executives, quality improvement professionals, equity officers, data analysts, and frontline clinical teams. Its modular structure allows organizations at any stage of their equity journey—from those just beginning to collect demographic data to those with mature equity programs—to implement the approach incrementally.
As the U.S. health care system continues to grapple with persistent and often widening disparities, the IHI’s new framework offers a timely and vital roadmap. By providing a common language and methodology for measuring equity, it empowers organizations to move beyond rhetoric and toward tangible, data-driven action. In doing so, it represents a significant step toward a future where every patient—regardless of race, ethnicity, income, geography, or identity—receives the highest standard of care.
The white paper is now available on the IHI website, along with supplementary tools and implementation resources. IHI encourages health care leaders nationwide to adopt this framework as a foundational element of their equity strategies, fostering a more just, effective, and resilient health care system for all.
