ercent of States. This suggests that Massachusetts may want to focus system-wide efforts on improving diabetes care quality.
Michigan: Figure 3.4.C shows that:
- Michigan is similar to the national average across all States for three of four process measures. For HbA1c testing two or more times per year, and annual eye exams and foot exams, Michigan rates are not statistically different from the national average and the differences are within 5 percentage points.
- Michigan is below the best-in-class average. Michigan is below the best-in-class average on all four measures and the differences are statistically significant (Table 2.1). For two measures in particular, the differences are large. Rates for HbA1c testing two or more times per year in Michigan are 27 percentage points lower than the best-in-class average and rates for influenza immunizations are 32 percentage points lower. This result calls for local study and possibly identifies an opportunity for Michigan to focus activities more widely on HbA1c testing and influenza vaccinations for people with diabetes.
Washington State: Figure 3.4.D shows the following for Washington:
- Washington State performs better than the national average on influenza immunizations for people with diabetes. The Washington rate (49.6 percent) is 12 percentage points higher than the national average, and the difference is statistically significant. Furthermore, although Washington is not one of the top decile States (with values averaging 59 percent and ranging from 56 to 64 percent, Table 2.1), Washington did test as not statistically significant from the top decile, given the amount of variation among and within the States. Thus, Washington is doing relatively well in vaccinating its diabetes population. However, given that rates of immunization are low in all States, benefits are possible from activities aimed at improving immunization of people with diabetes against influenza.
- Washington is similar to the national average on the other three process measures. Rates for the State are similar to the national average for HbA1c tests two or more times per year, and annual eye exams, and foot exams. Washington's rates are higher than, but within 5 percentage points, of the national average. Washington, however, is not among the top decile States when compared with best-in-class averages (go to Table 2.1).
Keep in mind that data on diabetes process measures provide a partial picture of diabetes care in each State. Outcome measures would be a valuable addition for understanding the impact of care processes in each State. The NHQR provided one of its diabetes outcome measures — avoidable admissions for uncontrolled, uncomplicated diabetes — by 14 States including the four example States reviewed above. These data are discussed in Step 2.