Evidence-Based Health Content and the Development Process

Our commitment

Krames StayWell (KSW) defines health content as that which provides clients with valuable information on diseases, conditions, tests, and procedures and helps promote understanding and management of health and wellness to their end-users. Health content is developed with the goal of being consistent with evidence-based medicine and nationally accepted guidelines and standards of practice. KSW health content is developed using clinicians whose expertise falls in the content area under development. KSW makes a significant investment annually to medically review health content and support its commitment to current high standards of accuracy. For new content, the staff is dedicated to developing health communication solutions that are evidence-based, URAC-accredited, easy to understand, and behavioral-change focused.

Content development, sourcing, reviews, and edits/updates

Content is developed for a range of reading levels, from fifth to 12th grades. Reading level is measured with commonly used readability scales (FOG, SMOG, Flesh-Kincaid and FRY). Going beyond readability, KSW is focused on health literacy, developing content using Doak, Doak & Root Suitability Assessment of Materials (SAM) methodology, which considers the following criteria: content, layout and typography, graphics, cultural appropriateness, learning stimulation motivation, and literacy demand. A glossary of terms is included on our online site. Multimedia content facilitates a low-literacy reading level with medical illustrations and a diverse selection of multimedia products.

All health content is sourced and dated when edited, revised, or updated. Health content is reviewed no later than 24 months from the article's posting date in the Unified Content Repository (UCR). Sources are up-to-date and consistent with evidence-based medicine and nationally accepted guidelines and standards of practice. The KSW staff adheres to a rigorous internal review process for existing content, and uses current health information leveraged from a variety of other renowned, credible content providers in the field, including Harvard, Health Day News, and Gold Standard, Inc.

The clinical review process for health content is conducted through an Editing and Recording Information System (ERIS). ERIS is a web-based application that allows for electronic content review and tracking. Health content is clinically reviewed by a minimum of two health content reviewers (for instance, medical doctor, doctor of osteopathy, registered nurse, clinical nurse specialist, advanced practice nurse, or physician assistant). At least one of the two reviewers must have expertise in the specialty area pertaining to the condition under review.

The review process for new and existing health content is as follows:

• New health content is sourced by the author. Two clinicians will review the new health content. One of the clinicians is an expert or specialist in the area pertaining to the condition under review.

• Existing heath content is reviewed by two clinicians, and one of the clinicians is an expert or specialist in the area pertaining to the condition under review.

• If revisions, updates, or edits are made to new or existing health content, the content is reviewed by two clinicians.

• Clinical content and health content are reviewed as appropriate when medical advances and/or new guidelines arise

  • Immediate Updates: Clinical content affected by significant new medical knowledge or identified with content errors (not spelling or grammar) is updated expediently. Electronic queries are generated in ERIS and/or the UCR to quickly locate articles that need revisions based on new medical knowledge.

ERIS serves as a mechanism to track and save revisions, updates, or edits made to health content, as well as the date, author, health content reviewer, and editor.

Self-management and Interactive tools - all calculators and condition-related risk assessments, as well as quizzes relating to specific health topics (smoking, weight loss, exercise, immunizations and screenings, pregnancy, stress, depression, and substance and alcohol use) - are also reviewed no later than 24 months from the posting date in the UCR. Other content is reviewed as appropriate, when medical advances or new guidelines arise.

KSW multimedia production has a strong commitment to quality and medical accuracy in its content development, visual representations, and data interaction. Guiding the development process in multimedia content are the same standards and requirements that direct the creation of all health content. Throughout the process of the creation of multimedia content, there are several different script/content reviews by the health content clinical team.

In production, the clinical staff reviews many visual beta versions of any production product developed by the graphic artists, animators, and programmers. With each step of the process, the clinical team has multiple opportunities to assure medical accuracy of the final product. All interactive multimedia content undergoes user testing by the staff and other consumer users.

KSW-owned multimedia content (animations, interactive tools, and clinical wizards) is reviewed no later than 24 months from the posting date in the UCR by our clinical content staff and other medically appropriate reviewers. Significant new medical knowledge or content errors are immediately addressed by the multimedia team.

Great importance is placed on visuals. Our award-winning art is used to:

• Bridge learning barriers - Visuals speak across languages and literacy levels.

• Convey key messages - Images reinforce key content.

• Tie content and audience together - Offer real-life examples and solutions.

KSW research methods include (journal articles, practice guidelines, subscription databases), consultations with medical experts, attendance at health care association meetings and conferences, professionally conducted surveys, roundtable discussions with industry professionals, and focus groups with both practitioners and end-users of our products.

Our Quality Oversight Committee receives a quarterly report on the medical review process of clinical content from the director of digital content, as well as clinical updates made to accommodate new medical practices and knowledge.

Medical reviewers

KSW medical reviewers - licensed clinically-experienced health care providers - are charged to assure that the content is evidence-based and that recommendations made on a particular topic are consistent across all content on that topic.

To ensure accurate and accessible content, KSW has an in-house team of:

• Project manager

• Medical Writers

• Certified Medical illustrators

• Medical editors

Health and clinical content developers

KSW employs a highly skilled team of medical authors, editors, and reviewers; most reviewers are independent contractors. Each medical writer has many years of experience in writing patient education materials for hospitals, health systems, private organizations, and professional organizations. Each advanced practice registered nurse (APRN), physician assistant, or physician also has numerous years of professional experience. 

Practice guidelines we follow

In developing content, KSW incorporates the current standards of care and practice guidelines of organizations not limited to those listed below:

Cardiology:

• American Heart Association

• American College of Cardiology

• Department of Health and Human Services

Dental:

• American Dental Association

• American Academy of Periodontology

• American Society of Reproductive Medicine

• American Association of Orthodontists

• American Association of Oral and Maxillofacial Surgeons

• American Academy of General Dentistry

• American Academy of Implant Dentistry

• American Academy of Pediatric Dentistry 

• American Association of Endodontists

• American College of Prosthodontics

Diabetes:

• American Diabetes Association

• American Podiatric Medical Association

• International Diabetes Center

• National Institute of Diabetes and Digestive and Kidney Diseases

• Academy of Nutrition and Dietetics

Eye care:

• American Academy of Ophthalmology

• American Society of Cataract & Refractive Surgery

• Eye Surgery Education Council

Gastroenterology:

• American College of Gastroenterology

• American Cancer Society

• American Society of Colon and Rectal Surgery

• National Comprehensive Cancer Network

• National Digestive Diseases Information Clearinghouse

• American Society of Colon & Rectal Surgeons

• Society of American Gastrointestinal Endoscopic Surgeons

OB/GYN:

• American Congress of Obstetricians and Gynecologists

• American Association of Gynecological Laparoscopists

• American Academy of Family Physicians

• National Institutes of Health

• American Society of Reproductive Medicine

• American Academy of Pediatrics

• American Society for Colposcopy and Cervical Pathology

• American Society of Reproductive Medicine

• Society of Reproductive Surgeons

• North American Menopause Society

Oncology:

• American Cancer Society

• National Cancer institute

• National Cervical Cancer Coalition

• American Congress of Obstetricians and Gynecologists

• American Institute for Cancer Research

• National Comprehensive Cancer Network

• American Society of Colon & Rectal Surgeons

Orthopedics:

• American Association of Orthopaedic Surgeons

• National Association for Sport and Physical Education

• North American Spine Society

Public health (includes infectious disease):

• Centers for Disease Control and Prevention

• American Social Health Association

Pulmonary:

• American Academy of Allergy, Asthma & Immunology

• Asthma and Allergy Foundation of America

• American Lung Foundation

• National Heart, Lung, and Blood Institute

• GOLD: Global Initiative for Chronic Obstructive Lung Disease

• American College of Chest Physicians

• American Association for Cardiovascular and Pulmonary Rehabilitation

Urology:

• American Urological Association

KSW content - whether existing and being updated or new - is intelligently indexed and mapped to MeSH concepts as a common keyword scheme. MeSH (Medical Subject Headings) is an industry-standard vocabulary maintained by the National Library of Medicine.

Sources

Sources and publications include, but are not limited to:

Allergies:

• Immunology and Allergy Clinics of North America

• Journal of Allergy & Clinical Immunology

• Middleton Allergy: Principles and Practice

Alternative medicine:

• Integrative Medicine

• Wilderness & Environmental Medicine

Bariatrics:

• Obesity Research & Clinical Practice

Cardiology:

• American Heart Association/American Stroke Association

• American College of Cardiology

• American Association for Cardiovascular and Pulmonary Rehabilitation

• Heart Failure Society of America

• Heart Rhythm Society

• Society for Cardiovascular Angiography and Interventions

• Society of Thoracic Surgeons

• American Association of Thoracic Surgery

• American Society of Hypertension

• Society of Invasive Cardiovascular Professionals

• American Heart Journal

• Braunwald's Heart Disease – A Textbook of Cardiovascular Medicine

• Cardiology Clinics

• Circulation (AHA Journals)

• Clinical Electrocardiography: A Simplified Approach

• Heart, Lung, and Circulation

• Journal of the American Society of Echocardiography

• Journal Watch for Cardiology

• Nadas' Pediatric Cardiology

• Pediatric Cardiology for Practitioners

• Progress in Cardiovascular Nursing

• American Journal of Cardiology

Complementary medicine:

• Integrative Medicine

• Textbook of Natural Medicine

Dentistry:

• American Journal of Orthodontics and Dentofacial Orthopedics

• Journal of the American Dental Association

Dermatology:

• Clinical Dermatology, 5th Edition

• Dermatologic Clinics

• Journal of the American Academy of Dermatology

Developments in medicine:

• CDC - HIV/AIDS Surveillance Report

• Healthcare Informatics

• Internet Medicine

• JAMA: Journal of the American Medical Association

• Medical Clinics of North America

• New England Journal of Medicine

• The Nation's Health

• Postgraduate Medicine

Diabetes:

• American Diabetes Association

• American Podiatric Medical Association

• International Diabetes Center

• National Institute of Diabetes and Digestive and Kidney Diseases

• Academy of Nutrition and Dietetics

• American Association of Diabetes Educators

• Endocrine Society

• Juvenile Diabetes Research Foundation

• National Kidney Foundation

• The Diabetes Educator

• ADA: Diabetes Forecast - The Healthy Living Magazine

• Diabetes Self-Management

Emergency medicine:

• Annals of Emergency Medicine

• American Journal of Emergency Medicine

• Clinical Procedures in Emergency Medicine

• Clinical Toxicology

• Emergency Medicine Clinics of North America

• Rosen's Emergency Medicine

• Wilderness Medicine

• Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose

Endocrinology:

• Endocrinology and Metabolism Clinics of North America

• Best Practice & Research Clinical Endocrinology & Metabolism

• The Journal of Clinical Endocrinology and Metabolism

• Williams Textbook of Endocrinology

Eye care:

• American Academy of Ophthalmology

• American Society of Cataract & Refractive Surgery

• Eye Surgery Education Council

• American Academy of Optometry

Family practice:

• American Family Physician

• Annals of Family Medicine

• Disease-a-Month

• Family Practice Management

• Physicians' Desk Reference

• Rakel's Textbook of Family Practice

• Textbook of Family Practice

• Ferri's Clinical Advisor

Gastroenterology:

• American College of Gastroenterology

• American Cancer Society

• American Journal of Gastroenterology

• National Comprehensive Cancer Network

• National Digestive Diseases Information Clearinghouse

• American Society of Colon & Rectal Surgeons

• Clinics in Liver Disease

• Gastrointestinal Endoscopy

• Gastroenterology Clinics of North America

• Sleisenger & Fordtran's Gastrointestinal and Liver Disease

General health and wellness:

• Canadian Medical Association Journal

• The Nation's Health

Geriatrics:

• Clinics in Geriatric Medicine

• Journal of the American Geriatrics Society

• Practice of Geriatrics

Health statistics:

• American Journal of Public Health

• The Nation's Health

• Statistical Abstract of the United States

• U.S. Government Manual

Hematology:

• Hematology: Basic Principles and Practice

Hospice and palliative care:

• Palliative Medicine

Infectious diseases:

• Infectious Disease Clinics of North America

• Infectious Diseases Society of America

• Lancet Infectious Diseases

• Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases

• Principles and Practice of Pediatric Infectious Diseases

Internal medicine:

• Annals of Internal Medicine

• American Journal of Medicine

• Cecil Textbook of Medicine

• Clinical Toxicology

• Chest

• Clinics in Chest Medicine

• Conn's Current Therapy

• Current Clinical Medicine

• Disease-a-Month

• Ferri's Clinical Advisor 2013

• Goldman's Cecil Medicine

• Hematology: Basic Principles and Practice

• Internal Medicine News

• Journal of Critical Care

• Mayo Clinic Health Letter

• Osler Medical Handbook

• Postgraduate Medicine

• Practical Guide to the Care of the Medical Patient

• Textbook of Respiratory Medicine

• Up-To-Date

Laboratory medicine:

• Clinical Laboratory News

• Clinical Chemistry

• American Association for Clinical Chemistry

• Henry's Clinical Diagnosis and Management by Laboratory Methods

• Laboratory Tests and Diagnostic Procedures

• Manual of Laboratory and Diagnostic Tests

• Mosby's Manual of Diagnostic and Laboratory Tests

Mental health:

• National Institute of Mental Health

Nephrology:

• Brenner and Rector's The Kidney

• Journal of the American Society of Nephrology

• American Journal of Kidney Diseases

Neurology:

• Bradley's Neurology in Clinical Practice

• Lancet Neurology

• Neurologic Clinics

• Neurology

• Pediatric Neurology

• Textbook of Clinical Neurology

Nutrition:

• Food Insight

• Journal of the Academy of Nutrition and Dietetics

• Journal of the American Dietetic Association

• Nutrition Action Health Letter

OB/GYN:

• American Congress of Obstetricians and Gynecologists

• American Association of Gynecological Laparoscopists

• American Academy of Family Physicians

• National Institutes of Health

• American Academy of Pediatrics

• American Society for Colposcopy and Cervical Pathology

• American Society of Reproductive Medicine

• North American Menopause Society

• American Journal of Obstetrics & Gynecology

• Clinics in Perinatology

• Contemporary OB/GYN

• The Female Patient

• Gabbe's - Obstetrics: Normal and Problem Pregnancies

• Evidence-based Obstetrics & Gynecology

• Obstetrics & Gynecology

• Obstetrics and Gynecology Clinics of North America

Oncology:

• American Institute for Cancer Research Newsletter

• Abeloff's Clinical Oncology

• Hematology/Oncology Clinics of North America

• American Cancer Society

• National Cancer Institute

• Evidence-based Oncology

• National Institutes of Health 

• Leukemia and Lymphoma Society

• Lancet Oncology

• National Comprehensive Cancer Network

Ophthalmology:

• American Journal of Ophthalmology

• Ophthalmology Management

• Ophthalmology Times

• Review of Ophthalmology

• Up-To-Date

• Yanoff & Duker - Ophthalmology

Orthopedics and orthopedic surgery:

• American Association of Orthopaedic Surgeons

• American Academy of Orthopaedic Surgeons

• American Journal of Sports Medicine

• Arthritis Today

• Campbell's Operative Orthopaedics

• Clinics in Sports Medicine

• DeLee and Drez's Orthopaedic Sports Medicine

• Journal of Bone and Joint Surgery

• Journal of the American Academy of Orthopaedic Surgeons

• National Association for Sport and Physical Education

• North American Spine Society

• National Osteoporosis Foundation

• Orthopaedic Nursing

• Orthopedics Today

• Scoliosis Research Society

• Browner - Skeletal Trauma

• Skeletal Trauma in Children

• Orthopedic Clinics of North America

• Physical Therapy Journal

• Podiatry Management

• Rheumatic Disease Clinics of North America

• Skeletal Trauma: Basic Science, Management, and Reconstruction

Otolaryngology:

• Otolaryngologic Clinics of North America

• Cummings Otolaryngology - Head and Neck Surgery

Pathology:

• Robbins and Cotran Pathology Basis of Disease, Professional Edition

• Henry's Clinical Diagnosis and Management by Laboratory Methods

Patient education and care:

• American Journal of Health Promotion

• American Journal of Managed Care

• Conn's Current Therapy

• Critical Care Clinics

• Critical Care Medicine

• Essentials of Physical Medicine and Rehabilitation

• Ferri's Clinical Advisor

• Hospitals and Health Networks

• Nursing Made Easy

• Ferri: Practical Guide to the Care of the Medical Patient

• Primary Care Clinics in Office Practice

• Textbook of Primary Care Medicine

Pediatrics:

• Clinical Pediatric Emergency Medicine

• Current Problems in Pediatric and Adolescent Health Care

• Harriett Lane Handbook

• Journal of Pediatric and Adolescent Gynecology

• Journal of the American Academy of Child and Adolescent Psychiatry

• Journal of Pediatrics

• Nelson Textbook of Pediatrics

• Paediatric Respiratory Reviews

• Pediatric Neurology

• Pediatric Cardiology for Practitioners

• Pediatric Clinics of North America

• Pediatric Critical Care Medicine

• Principles and Practices of Pediatric Infectious Diseases

• Skeletal Trauma in Children

Pharmacology:

• Advice for the Patient (USP DI: v.2 Advice for the Patient)

• Approved Drug Products and Legal Requirements (USP DI, v.3)

Physical medicine and rehabilitation:

• Essentials of Physical Medicine and Rehabilitation

Public Health:

• Centers for Disease Control and Prevention

• American Social Health Association

• Evidence-based Healthcare and Public Health

• Evidence-based Healthcare: A Scientific Approach to Health Policy

• CDC - National Center for Health Statistics

• National Institute of Allergy and Infectious Diseases

Psychiatry:

• Handbook of Medical Psychiatry

• General Hospital Psychiatry

• Journal of the American Academy of Child and Adolescent Psychiatry

• Psychiatric Clinics of North America

• Jacobson - Psychiatric Secrets

Pulmonary medicine:

• American Academy of Allergy, Asthma & Immunology

• Asthma and Allergy Foundation of America

• American Lung Association

• National Heart, Lung, and Blood Institute

• GOLD: Global Initiative for Chronic Obstructive Lung Disease

• American College of Chest Physicians

• American Association for Cardiovascular and Pulmonary Rehabilitation

• Paediatric Respiratory Reviews

• Heart, Lung, and Circulation

• Chest

• Murray and Nadel's Textbook of Respiratory Medicine

Radiology:

• Grainger & Allison's Diagnostic Radiology

• Radiologic Clinics of North America

• Essentials of Radiology

Rheumatology:

• Kelley's Textbook of Rheumatology (Book /  MD Consult)

Safety:

• Family Safety & Health

• National Safety Council

• Journal of Occupational and Environmental Medicine

• Occupational Safety & Health Administration

• National Institute for Occupational Safety & Health

• National Clearinghouse for Worker Safety and Health Training

• U.S. Chemical Safety Board

• Safety + Health

Sports medicine:

• American Journal of Sports Medicine

Surgery, general:

• American Society of Anesthesiology

• Anesthesiology Clinics

• American Journal of Surgery

• Bulletin of the American College of Surgeons

• General Surgery News

• Journal of the American College of Surgeons

• Journal of Clinical Anesthesia

• Khatri - Operative Surgery Manual

• Operative Techniques in General Surgery

• Outpatient Surgery Magazine

• Sabiston Textbook of Surgery

• Surgical Clinics of North America

Trends in health:

• American Journal of Public Health

• Trends in Men's Health

• Journal of Men's Health

• Journal of Men's Health and Gender

• Trends in Women's Health

• Journal of Women's Health

Urology:

• American Urological Association

• National Kidney Foundation

• American Journal of Kidney Diseases

• Brenner & Rector's The Kidney

• Campbell-Walsh Urology

• Urology

• Urologic Clinics of North America

• Journal of the American Society of Nephrology  

Approved by the Quality Oversight Committee, September 2012

Revised: October 2012