Introduction State efforts to identify subpopulations at higher risk for inadequate diabetes maintenance are sometimes hampered by small sample size. We provide a model of a cross-state collaboration that might provide the foundation for identifying political and economic forces underlying inter-and intra-state variability in chronic disease care. Conclusion Inadequate annual diabetes care among adults with diagnosed diabetes was endemic even in this relatively advantaged US census division, and traditional disparities (eg, race/ethnicity, FPL bracket) only partially explained patterns in diabetes maintenance activities. Interstate analyses can create the foundation for active partnerships to identify and address the causes of lapses in care.
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