The performance of primary care clinics has dipped slightly in Minnesota, according to a new state report card, so that fewer patients with chronic diseases such as diabetes are staying at optimal levels of health.

Only 45 percent of adults with diabetes were at optimal health last year, compared to 46 percent a year earlier, according to Minnesota Community Measurement’s annual report on clinical management of patients with chronic diseases.

Health officials didn’t express dismay over the minute drop, though. While it goes against years of progress, the decline mostly reflects a change in the way clinics are graded, said Julie Sonier, president of Minnesota Community Measurement, a nonprofit agency that rates clinics on quality of care and costs.

The old analysis assessed clinics by the health of patients who made regular appointments. But the new approach includes patients who rarely seek appointments — patients who presumably are in worse health because they don’t seek out recommended medical care.

“We heard from providers that there’s this whole group of people that have this condition that should be included in the measure, but weren’t,” Sonier said.

Clinicians such as Kendra Oestreich agreed that there’s room for progress, and that they haven’t peaked in the percentage of patients with diabetes, asthma or vascular disease who can achieve optimal health.

Her Fairview Rosemount clinic was among the best in the state in its patient management. Sixty percent of its adult patients with diabetes were at optimal health last year — which means they didn’t smoke, had acceptable levels of blood pressure and blood sugar, and took daily aspirin, if needed, and statin medications to manage cholesterol.

Some patients can be challenging such as die-hard smokers who claim they’ll never quit, she said. But each clinic visit is another chance.

“We still ask them at every visit, ‘Are you interested in quitting smoking today?’ ” said Oestreich, who is a physician assistant. “I don’t think we ever give up in that sense.”

The Rosemount clinic takes steps such as reviewing patient’s scores monthly and calling patients who have concerns and making sure they have appointments scheduled.

In the end, Oestreich said, it’s up to patients whether they eat right and exercise. But clinicians should be talking with them about those habits and any barriers to making healthy choices or receiving recommended medical care, she said.

“If you can find out what the barrier is, I think patients are interested in making the good choice.”