title: Web-Based Quality Assurance Process Drives Improvements in Obstetric Ultrasound in 5 Low- and Middle-Income Countries.
abstract: High quality is important in medical imaging, yet in many geographic areas, highly skilled sonographers are in short supply. Advances in Internet capacity along with the development of reliable portable ultrasounds have created an opportunity to provide centralized remote quality assurance (QA) for ultrasound exams performed at rural sites worldwide. We sought to harness these advances by developing a web-based tool to facilitate QA activities for newly trained sonographers who were taking part in a cluster randomized trial investigating the role of limited obstetric ultrasound to improve pregnancy outcomes in 5 low- and middle-income countries. We were challenged by connectivity issues, by country-specific needs for website usability, and by the overall need for a high-throughput system. After systematically addressing these needs, the resulting QA website helped drive ultrasound quality improvement across all 5 countries. It now offers the potential for adoption by future ultrasound- or imaging-based global health initiatives.
authors.affiliation: University of Washington Medical Center, Seattle, WA, USA. swanson5@uw.edu.
authors.forename: Jonathan O
authors.initials: JO
authors.lastname: Swanson
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Plotner
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Franklin
authors.affiliation: University of Washington Medical Center, Seattle, WA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Swanson
authors.affiliation: University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Victor
authors.initials: V
authors.lastname: Lokomba Bolamba
authors.affiliation: University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Adrien
authors.initials: A
authors.lastname: Lokangaka
authors.affiliation: Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala.
authors.forename: Irma
authors.initials: I
authors.lastname: Sayury Pineda
authors.affiliation: Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala.
authors.forename: Lester
authors.initials: L
authors.lastname: Figueroa
authors.affiliation: Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala.
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.affiliation: Moi University School of Medicine, Eldoret, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Muyodi
authors.affiliation: Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.affiliation: Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kanaiza
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Waseem
authors.initials: W
authors.lastname: Mirza
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Farnaz
authors.initials: F
authors.lastname: Naqvi
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Musaku
authors.initials: M
authors.lastname: Mwenechanya
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Melody
authors.initials: M
authors.lastname: Chiwila
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Hamsumonde
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Columbia University, New York, NY, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.affiliation: University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Nathan
mesh_terms: D003223:Congo; D003906:Developing Countries; D005260:Female; D006166:Guatemala; D006801:Humans; D020407:Internet; D007630:Kenya; D009774:Obstetrics / Q000592:standards*; D010154:Pakistan; D011247:Pregnancy; D058996:Quality Improvement; D017216:Telemedicine / Q000592:standards*; D014463:Ultrasonography / Q000592:standards*; D015024:Zambia