n the State and the effectiveness of the better-than-average HbA1c testing in Georgia.
- Georgia does not differ statistically from the national average on the three process measures that relate to eye exams, foot exams, and influenza vaccination for adults with diabetes. The absence of a statistically significant difference has to be tempered with the fact that BRFSS samples for individual States are often quite small and probably too small to have the power to detect a difference of the size measured here, even if it exists. Thus, the higher rates of eye exams (statistically significant) are simply inconclusive. When compared to the more stringent benchmark of the best-in-class rates for these measures, however, Georgia is not one of the top 10 percent of States (go to Table 2.1). This is especially true for immunization against influenza where there is almost a 30-percentage-point difference between Georgia's rate and the best-in-class average (30 percent versus 59 percent).
Massachusetts: Figure 3.4.B reveals the following about Massachusetts compared to national norms:
- Massachusetts appears to be close to the national average on all of the NHQR process measures for diabetes care quality, using the test of statistical significance. However, because of the small sample sizes of the BRFSS, consider the magnitude of the differences from the national average. Massachusetts' average for HbA1c testing two or more times per year is 8 percentage points higher than the average State and for flu immunizations its average is 7 points higher — notable differences. In both cases, however, the amount of variation among the States and within Massachusetts makes these statements equivocal, and the higher values could as likely be due to chance as to better performance.
- Massachusetts is not among the top decile States when compared to best-in-class estimates. Massachusetts' lower values are statistically different (go to Table 2.1), which means the differences are unlikely to be chance occurrences compared to the top 10 percent 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 th