Health Navigator strives to use an evidence-based approach to developing and updating the clinical content.

The Health Navigator Clinical Editorial Team utilize a standardized hierarchy for evaluating the quality of the evidence and deciding how to best apply this information in a practical manner. This hierarchy follows a step-wise level of evidence is shown below.

Level 1 Evidence Sources

National and International Guidelines from Government and Government-sponsored Organizations

Source
Acronym
Country
Advisory Committee on Immunization
https://www.cdc.gov/vaccines/acip/index.html
ACIP US
Agency for Healthcare Research and Quality
https://www.ahrq.gov/
AHRQ US
Centers for Disease Control and Prevention
https://www.cdc.gov/
CDC US
Centers for Medicare and Medicaid Services
https://cmit.cms.gov/CMIT_public/ListMeasures
CMS US
National Cancer Institute
https://www.cancer.gov/
NCI US
National Health System
https://www.nhs.uk/pages/home.aspx
NHS UK
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov/
NHLBI US
National Institute for Health and Care Excellence
https://www.nice.org.uk/
NICE UK
National Institute for Occupational Safety and Health
https://www.cdc.gov/niosh/az/l.html
NIOSH US
National Institutes of Health
https://www.nih.gov/health-information
NIH US
Public Health Agency of Canada
https://www.canada.ca/en/public-health.html
PHAC CA
US Preventive Services Task Force
https://www.uspreventiveservicestaskforce.org/
USPSTF US
World Health Organization
http://www.who.int/health-topics/
WHO International

Level 2 Evidence Source

Clinical Guidelines from Professional Medical Societies

Source
Acronym
Country
American Academy of Family Physicians
https://www.aafp.org/, https://familydoctor.org/
AAFP US
American Academy of Pediatrics
https://www.aap.org, https://www.healthychildren.org/
AAP US
American College of Emergency Physicians
https://www.acep.org/patient-care/clinical-policies/
ACEP US
American College of Obstetricians and Gynecologists
https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins-List, https://www.acog.org/Patients
ACOG US
American College of Physicians
https://www.acponline.org/
ACP US
American College of Surgeons
https://www.facs.org/
ACS US
American Diabetes Association
http://www.diabetes.org/
ADA US
American Heart Association
https://www.heart.org/en/
AHA US
Choosing Wisely – ABIM Foundation
http://www.choosingwisely.org/
US
And others…

Level 3 Evidence Source

Systematic Reviews and Respected References

Source
Cochrane Database of Systematic Reviews
https://www.cochrane.org/
UpToDate
https://www.uptodate.com/
And others

Level 4 Evidence Source

Peer-reviewed Medical Journals

PubMed (https://www.ncbi.nlm.nih.gov/pubmed) is used to search the medical literature when developing or updating clinical content. Articles from peer-reviewed, higher impact journals are given preferential consideration.

Source
Acronym
Country
Annals of Emergency Medicine US
British Medical Journal BMJ UK
Journal of the American Medical Association JAMA US
Lancet UK
New England Journal of Medicine NEJM US
Obstetrics & Gynecology ACOG US
Pediatrics US
And others

Level 5 Evidence Source

Subject Matter Experts

Input from Health Navigator Medical Review Board members and Clinical Consultants is sought when evidence is limited or lacking, and there are no clearly applicable practice guidelines from respected Level 1 or 2 Evidence Sources.

Level 6 Evidence Source

Data Analysis and Research

Health Navigator has an ongoing quality improvement and testing process.

We test all aspects of the digital health encounter: the beginning (chief complaint vocabulary, natural language processing), the middle (“tell us more” clinical vocabulary, use of plain language), and the end (triage and diagnosis outputs, care advice).

Example sources of de-identified data, which are reviewed, tested, and analyzed on an ongoing basis include: medical call center, emergency department, symptom checker, and telemedicine encounters.

Some of the results from Health Navigator analyses and research are available for review on the Research page of the Health Navigator website.

Level 7 Evidence Source

Other

Source
Quality improvement data and feedback from telemedicine organizations
Quality improvement data and feedback from medical call centers (nurse advice lines)
Internet research

Evaluating research quality is a challenging task. Often published research-based evidence is lacking or missing. It is important to “balance evidence-based practice with practice-based medicine”, while considering patient values, preferences, and context. Results from data science, testing, and quality improvement activities should be an integrated part of clinical content development activities.

References

  • Canadian Task Force on the Periodic Health. The periodic health examination. Canadian Task Force on the Periodic Health Examination. Can Med Assoc J. 1979 Nov 3;121(9):1193-254. 115569
  • US. Preventive Services Task Force (August 1989). Guide to clinical preventive services: report of the U.S.Preventive Services Task Force. DIANE Publishing.
  • Oxford Centre for Evidence-based Medicine – Levels of Evidence (March 2009). Centre for Evidence-Based Medicine.
  • OCEBM Levels of Evidence. Available at https://www.cebm.net/2016/05/ocebm-levels-of-evidence/
  • Reflections from medical practice: balancing evidence-based practice with practice-base evidence. Ed Peile. In  In Thomas, G.; Pring, R. Evidence-based Practice in Education. Open University Press. pp. 102–16. Available at: https://books.google.com/books?id=NxFg9E13bwQC&pg=PA102#v=onepage&q&f=false.

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