Module 3: Information — Interpreting State Estimates of Diabetes Quality

Diabetes Care Quality Improvement: A Workbook for State Action

Learning Objectives

Upon completion of this module, the user(s) will be able to:

Identify State rates benchmarks for the four major measures and assess those rates in relation to national averages and other States. (There are many types of benchmarks—national average, best-in-class performance, and national consensus-based-goal benchmarks.)
Identify factors that influence a State's position among other States. (Knowing these factors can help States assess how difficult it may be to change and where States should target their efforts.)
Identify the benchmarks to be used to set goals for improving diabetes care. (Any of the benchmarks listed above can be used to set goals. Aiming for the average is usually the least rigorous goal, while striving to be the best-in-class is usually the most rigorous, achievable goal. Knowing your State's position as it relates to the full distribution of State rates also shows how well the State is doing among all States. A State that is among the lowest in the Nation on a particular dimension might want to focus improvement in that area.)
Draft preliminary goals for specific measures.(Knowing what you want to achieve in the long term will help States identify the resources and tools they need to get there.)

1. Identify State rates to use as benchmarks for the four major measures and assess those rates in relation to national averages and other States.

Read Module 3. Note the various definitions of benchmarks on Step 1.

a. With a colored pen or pencil, take the figures you wrote down in question 2a, in Module 2 and mark the percentage on the appropriate line in the chart below.

Copy of Figure 3.2 in the Diabetes Care Quality Improvement Guide. For text description go to <a href= "

[D] Select for Text Description

b. Note whether your State rates fall above or below the national average benchmarks and where they are in relation to other States. Go back to Table 2.1 of the Resource Guide for the rates by State. Are any of the percentages for your State:

1) Significantly above the national average (indicated by a "+" sign next to the value for your State rate)? Which ones?

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2) Significantly below the national average (indicated by a "-" sign next to the rate)? Which ones?

3) Within the best-in-class range and, thus, not significantly different from the best-in-class average (indicated by a ‡ sign, which says that the State is either one of the best-performing States or is within a margin of error of these States)? Which ones?

4) Significantly below the best-in-class range (does not include a ‡ sign next to the State rate)? Which ones?

c. Read pages in Module 3, Step 1 see how four States were examined in the Resource Guide. Write a similar analysis of your State's data. Is your State doing well in any areas? Where could you improve?

2. Identify factors that influence a State's position among other States.

Review pages Module 3, Step 2 of the Resource Guide on the factors that affect diabetes quality of care.

a. What do you know about your State, its infrastructure, and your State's population that would account for your State's position on the chart above? Does your State have a large minority or elderly population? What resources are available for the uninsured? (The Kaiser Family Foundation maintains a Web site with State-level measures for many health and demographic indicators; go to http://www.statehealthfacts.org/.)

b. Study Figure 3.6. Note the relationships between hospital admissions, obesity, poverty, and diabetes prevalence.

1) What inferences can you make from the data?

2) What do you know about your own State's infrastructure, its population, obesity, poverty levels, the uninsured, public education, funding, and leadership? How might those factors affect people with diabetes?

3) If your State's data are not listed in Figure 3.6, how could you get these data for your State? (Hint: see your response to the data sources question from Module 2.)

3. Identify the benchmarks to be used to set goals for improving diabetes care.

Review the Resource Guide, Module 3, Step 1 and Appendix D, on benchmarks and your answers to Module 2, question 2 and Module 3, question 1. Note the best benchmarks to use and why different benchmarks might be chosen in different circumstances.

a. Which benchmarks for which measures would you select from Module 2, question 2a to strive for improving diabetes care in your State?

b. Write the figure in the appropriate blank below:

Test Type:	National average	Best-in-class average	National HP 2010 goal
HbA1c testing
Retinal eye examination
Foot exam
Flu vaccination			n/a

c. For each measure, why did you select that type of benchmark?

HbA1c test:

Retinal exam:

Foot exam:

Flu vaccination:

4. Draft preliminary goals for specific measures.

Review Step 1 pages of the Resource Guide for examples of how benchmark data were interpreted for four States.

a. Consider your State's data in relation to setting preliminary goals for a diabetes care quality improvement program. For each of the four measures, set a preliminary goal to reach the benchmarks you selected in Module 3, question 3. Some examples of goal statements are:

Increase the number of adults with diabetes who receive an HbA1c test at least once a year to the level of the national average - 61 percent.
Increase the number of adults with diabetes who receive an HbA1c test at least once in a year to the best-in-class average - 82 percent.
Increase retinal exam testing for adults with diabetes by 5 percentage points within the next 3 years.
Increase the number of adults with diabetes who receive foot examinations from their physicians to reach the Healthy People 2010 goal - 75 percent.
Increase the number of adults with diabetes who receive flu vaccinations to the best-in-class average - 58 percent.
Identify the barriers to obtaining HbA1c testing or retinal exams or foot examinations or flu vaccinations.
Begin collecting data on any or all of the measures (if your State does not already have these data).

Guidance for Setting Goals:

Consider this goal-setting exercise as preliminary to enhance your understanding. (Stakeholders who will become champions of the initiative must have a part in setting goals for the program. Only in that way will the goals reflect the circumstances that the community faces and be supportable by leaders in the health care community.)
Note where your State falls on the chart in Module 3, question 1a: Is your State extremely low, close to the national averages, or within the best-in-class averages? (Your position on the chart will tell you how far your State must go to be among the best performing health care systems.) Do you want to set long-range and short-range goals?
Remember that you will have to identify and address the underlying issues that affect your State's position.
The four measures featured here are only a subset of the meaningful goals and are not necessarily the most effective goals for diabetes quality improvement in your State. (HbA1c levels, provider and patient education, adherence with recommended lifestyle changes, and focus on vulnerable populations are some of the important goals that your planning group may decide to set.)
As you move through the planning process and discover new information, you can come back and change your goals to reflect your new knowledge.
Your quality improvement program for diabetes care should ultimately be designed to reach the goals set by the full quality improvement team.

What are your preliminary goals for:

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HbA1c testing:
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Retinal exam:
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Foot exam:
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Flu vaccination:
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Page last reviewed August 2008

Internet Citation: Module 3: Information — Interpreting State Estimates of Diabetes Quality: Diabetes Care Quality Improvement: A Workbook for State Action. August 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/diabguide/diabwork/diabqworkmod3.html