Rates, numbers and averaged rankings: A strategy to inform site selection

Background: Selecting sites for program implementation given limited funding/resources is often based on rankings of highest rates or largest numbers of specific outcomes, which can preclude areas in greatest need for the services. Although complex weighting and adjustments can be done, statistical expertise may be required. We developed a simpler approach to select 20 states for continuing education related to preterm birth (PTB, <37 weeks).

Methods: We averaged the state rankings based on PTB rates with the state rankings based on largest numbers of PTBs and then ranked the averaged ranks. For the 50 states and DC rates and numbers of PTBs were ranked from highest (1) to lowest (51). These two ranks for each state were averaged and the averaged ranks were ranked from highest (1) to lowest (51).

Results: The top 20 states identified based on the averaged ranks were very different than the top 20 from either the ranked PTB rates or the ranked number of PTBs. For example, Ohio ranked 25th based only on ranked PTB rates but was 12th based on our averaged rank strategy; DC ranked 5th based on PTB rates alone but 28th based on the averaged rank strategy.

Conclusion: Our averaged ranked strategy based on both rates and numbers of PTBs provided a balanced list of states to target limited and important resources and can provide an approach for many public health programs. Application of this strategy can more efficiently allocate funding for interventions to sites with greatest need.