University of Wisconsin-Eau Claire

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University, Marshfield Clinic Researchers Conduct
Joint Study on Evidence-based Medicine

 MAILED:  March 22, 2004

EAU CLAIRE — The University of Wisconsin-Eau Claire and Marshfield Clinic are conducting a joint study dealing with evidence-based medicine, known as EBM.

The primary researchers are Dr. Ruth Cronje, an assistant professor of English, and Jim Freeman, D.O., a family physician in the Urgent Care Department at Marshfield Clinic Eau Claire Center.

Researchers are surveying Marshfield Clinic’s 1,200 physicians, physician assistants and nurse practitioners via a Web-based survey on EBM, using online survey software developed by faculty and students in UW-Eau Claire’s computer science department. The data collected will be used to compare and contrast changes over time as Marshfield Clinic clinicians and others embrace EBM in their medical practices.

“The information from the survey will be useful to administrators and may be helpful in creating training materials for clinicians as well as patient education materials,” Freeman said.

Ultimately the researchers hope to determine if EBM makes a difference in patient care. EBM is a hot topic in medicine today as clinicians, public health practitioners, purchasers, planners and the public seek consistent, quality medical care for all people.

Freeman said clinicians who practice EBM integrate clinical experience, patient preferences and best scientific evidence to produce the best health care outcome for all patients.

In the past, physicians relied on professional meetings and scientific journals to keep up on the latest medical research, said Cronje. Studies show most doctors found it difficult, if not impossible, to keep up with current findings and apply the best evidence to individual patients.

“Today large computer databases make it possible to use current best evidence in making decisions about the care of individual patients,” Cronje said. “Our goal is to find out how clinicians understand EBM and what they think of it.”

Marshfield Clinic is in the process of implementing a point of care computer system, which will be an important tool for accessing current best research results, Freeman said.

The project also has an international component. Cronje is working with a non-profit organization, the American International Health Alliance, in Washington, D.C., that has been active in promoting EBM in Central and Eastern Europe, Central Asia and newly independent states of the former Soviet Union. With the help of AIHA researchers, the survey was rewritten and validated and is being offered in Russian and English. In addition, Cronje is working with an Australian researcher to offer the survey at his site in Melbourne, Australia.

“By collecting tri-cultural data we can begin to address cultural differences related to the knowledge and practice of evidence-based medicine,” Cronje said. “World circumstances are so different and it will be interesting to see whether there are cultural or geopolitical disparities in the way clinicians understand and practice EBM.”

Faculty and students from UW-Eau Claire’s English, mathematics, computer science and psychology departments worked with Cronje and Freeman to deliver the Web-based survey. Thomas Moore, an assistant professor of computer science, and students Justin Ehlert, Arcadia, and Bret Lichtenwald, North Prairie, used work done previously in the department to develop Surveys OnLine, a system for creating and offering surveys online.

Moore credits psychology professor Blaine Peden for the idea of developing an online survey system. Surveys OnLine has progressed from a prototype written by students completing the Web minor to a project with significant enhancements written by computer science majors in the software engineering class to the full-feature system completed by Ehlert and Lichtenwald.

Challenges included delivering the survey through a Web browser, supporting multiple languages and ensuring security so the survey and collected information can’t be tampered with.

“The two students did a remarkable job,” Moore said. “The pressure was immense. In an academic exercise if you fail, you lose a few points. This was a real world exercise and the pressure to get it right was immense. It’s really astounding what they did.”

Cronje, who has a doctorate in scientific and technical communication and rhetoric, said it took months to develop the survey content to make it clear, concise and reliable. The survey, which takes 20 minutes to complete, includes multiple choice and essay-type questions.

Based on pilot testing, researchers expect a response rate of at least 60 percent. They will begin analyzing the data in April and continue through the summer.

The project involves people from UW-Eau Claire, Marshfield Clinic, AIHA, Monash University in Australia and Group Health Cooperative of Eau Claire.

“Just as the practice of evidence-based medicine needs to be collaborative, we’ve tried to be inclusive in this project,” Cronje said. “It’s impressive that UW-Eau Claire has an interdisciplinary community that allows English faculty to work with faculty from other departments as well as organizations throughout the region.”

UW-Eau Claire students and staff include Jason Wudi, from Computing and Networking Services; Jennifer Hamm, Cadott, graduate research assistant, and Rebecca Hutchinson, Monroe, and Lindsay Duwell, West Bend, undergraduate collaborators, from English; Norah Airth-Kindree, Hillsboro, a graduate nursing student of nursing professor Lois Taft; and mathematics professor Marc Goulet, assisted by undergraduate Danielle Aanenson, Hopkins, Minn. Other participants include the Eau Claire Area School District’s patient rights advocate Sue Fulkerson and Dr. Kristof Gehrke, a resident at the Marshfield Clinic in Marshfield.

Support for the project has come from UW-Eau Claire through grants from the Office of Research and Sponsored Programs and with the cooperation of the Marshfield Clinic.

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Updated: March 22, 2004