This case study describes how facility-level teams worked with department of health leaders in Tver Oblast, Russia, to create an evidence-based guideline as part of a larger quality improvement project to improve the system of healthcare delivery for women suffering from pregnancy-induced hypertension. In September 1997, the Health Committee of the United States – Russian Federation Joint Commission on Economic and Technological Cooperation decided to address issues of access to quality healthcare as a priority area for collaboration between the two countries. The United States Agency for International Development (USAID) was asked to provide technical assistance in quality improvement. USAID responded by providing assistance through the Quality Assurance (QA) Project. In June 1998, a task force outlined the scope of work (SOW) for the access to quality healthcare priority area. The SOW included two demonstration projects in maternal child health in Tver and one in primary care in Tula. The QA Project set up demonstration projects to adapt quality improvement methods to Russian organizational culture in close collaboration with Russian and U.S. organizations, including the Ministry of Health of the Russian Federation (MOH RF), the Central Public Health Research Institute (CPHRI) of the MOH RF, Tver Oblast Department of Health, the Agency for Health Research and Quality (AHRQ), and the U.S. Department of Health and Human Services. (excerpt)