Innovative methods for monitoring perinatal health outcomes in cities and in smaller geographic areas

Objectives. Monitoring health in small localities such as cities or local c ommunities is important, because rates of adverse outcomes often vary widel y by geographic area. This article explores the utility of CUSUM (cumulativ e summation), a method developed and refined in industry, for monitoring he alth outcomes in cities and smaller geographic areas. Methods. CUSUM monitoring methods were applied to rates of late or no prena tal care initiation and very low birthweight for the city of Baltimore as a whole and for a cluster of high-risk areas within the city. The performanc e of supplementary runs criteria was also assessed. The ability of both met hods to flag significant increases or decreases in prenatal care initiation and very low birthweight rates was assessed. Results. CUSUM and runs criteria detected most significant rate changes. Th e 2 methods performed better in regard to outcomes with higher prevalence a nd in larger geographic areas. Conclusions. CUSUM methods are convenient and reliable for use in the monit oring of moderately low prevalence outcomes in small geographic areas. Futu re research should examine their applicability to other health outcomes and further refine these methods, especially for rarer outcomes.