Telesonography Adaptation and Use to Improve the Standard of Patient Care Within a Dominican Community

Summary

The role of teleradiology has far reaching implications for the health of remote and underserved populations. The ability to coordinate radiographic evaluation and diagnosis from a distance has the potential to raise the standard of patient care throughout the world. Perhaps the safest and most cost effective mode of teleradiology today is telesonography. The current project attempts to determine the extent that telesonography improves the standard of care within a rural government-run primary clinic within the Dominican Republic. The work reported herein is intended to compare the use of telesonography to the current standard of sonographic examination (referral to government hospital 60km from target clinic). The study was conducted by randomly assigning 100 patients with clinical indications for sonographic examination into experimental and control groups. Following a 60-day implementation period, the following research questions will be addressed: 1) To what extent does the use of asynchronous telesonography increase the percentage of definitive diagnoses based on the total number of scans (definitive diagnoses / total number of scans)? 2) To what extent does the use of asynchronous telesonography increase the continuity of care for patients? 3) To what extent does the elapsed time between scanning and final radiological interpretation decrease with the use of asynchronous telesonography? This study will also look at the history of telemedicine / telesonography and its dissemination into the mainstream practice of medicine, explore training protocols that may be used to assist others to establish new telesonography programs in a developing nations, and discuss both advances and persistent barriers to the implementation of telesonography programs.

Hypothesis:

The use of a store-and-forward telesonography system in this setting will increase the speed and number of final diagnoses per scan received by the target clinic and will increase the continuity of care by increasing the number and speed of follow-up appointments to the target clinic.

Conditions

• Ascites
• Blunt Abdominal Trauma
• Cholelithiasis
• Cholecystitis
• Cholangitis
• Pancreatitis
• Hydronephrosis
• Abdominal Aortic Aneurysm
• Hepatitis
• Portal Hypertension
• Urolithiasis
• Abnormal Uterine Bleeding
• Ovarian Mass
• Ovarian Torsion

Interventions

DEVICE

SonoSite Titan portable ultrasound coupled with email telediagnosis

Sonographic exam will be performed by principal investigator. A "first-look" diagnosis, correlated with patient symptomology and laboratory analysis, will be made at the point of care. Using a store-and-forward framework, properly formatted non-compressed sonographic images and "Request for Interpretation" (RFI) forms will be transmitted to participating radiologists. RFI forms will be used to record diagnostic findings and rate the quality of the images and/or diagnostic value using a five-point Likert scale. RFI forms will also include a five-digit patient number, age, sex, and symptomology / reason for sonographic exam. Completed RFI forms will be transmitted back to the clinic at the radiologist's earliest convenience.

Sponsors & Collaborators

• Virginia Polytechnic Institute and State University

  collaborator OTHER

• Edward Via Virginia College of Osteopathic Medicine

  lead OTHER

Principal Investigators

• James E Sutherland, D.O. · Edward Via Virginia College of Osteopathic Medicine

• Dean Sutphin, Ph.D. · Edward Via Virginia College of Osteopathic Medicine

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

13 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2008-01-31

Primary Completion

2008-03-31

Completion

2008-03-31

Countries

• Dominican Republic

Study Locations