At Health Hippo, we know that we’d all love to access new medical insights quickly, while also understanding which medical truths are time-tested and enduring. But, let’s face it: as humans, we also want to find the fountain of youth and learn that there’s been a fantastic new pill, device, or action we can take to have good health, especially at times when we are suffering and not well. Our natural bias is to find “the easy button” and it can be breathtakingly difficult, however, to factually discern whether a new health innovation is a game-changer, or snake oil.
Today’s professional systems to disseminate medical information address this problem of separating what’s novel and effective, from what’s not, by being careful – but slowly, strikingly slowly. The seminal study says it takes 17 years to translate research about new health innovations to become mainstream practice. Seventeen years. You can read more about it here. While this study is almost a decade old, and let’s note the irony while on the topic of speed, it is still believed to be a reasonably valid estimate. There are powerful organizations, such as the Joanna Briggs Institute, that work on models and initiatives for more rapid translation.
What is a Confidence Grade?
At Health Hippo, we provide a fresh way to help you understand the state of innovation – and specifically the confidence that medical professionals have about managing a given health issue. We convey this by assigning a grade, on a scale from 0 to 100. A higher grade means relatively higher confidence that a given health issue can be properly diagnosed, a cause assigned, a treatment identified, and your expectations about the outcome can be properly set. And a lower grade means relatively lower confidence in each of those things. The grade itself is based on the Stoplight Ratings: Green-rated findings are supported by strong, time-tested evidence. Red-rated findings are also strong findings, but they represent disproven popular beliefs. And yellow-rated findings are supported by emerging, possible - and possibly conflicting - evidence.
The Confidence Grade then is, specifically, based on a numerator and denominator. The numerator is the number of green-rated findings, which represent findings with strong evidence, plus the number of red-rated findings, weighted at 50%. The denominator is the number of all rated findings for that condition. If a condition has a high number of yellow-rated findings, it will have a lower Confidence Grade. Red-rated findings are weighted at 50% because while it is helpful to know what won't work, it's more important to know what will work in managing a condition.
Let’s bring this to life by working through an example or two. For instance, hypertension is a disease with a high confidence grade, above 60, of 69. Why? The science behind identifying and treating hypertension is quite well-understood. And here's some simple math to go with that context.
- In total, we rated 16 individual findings.
- There are 9 green-rated findings for hypertension including, for instance, how it is diagnosed (hint: proper and repeated measurements are key to the diagnosis of hypertension). We count this as 9.
- There are also 4 red-rated findings. For instance, it's popularly believed that eating one particular food or taking one particular supplement can curb hypertension. That's not a true finding as it's been disproven. Because it is important to know what doesn't work, so it doesn't cloud the waters on what does work, we half-weight red-rated findings. For hypertension, that's a 2 (half of 4).
- Finally, there are 3 yellow-rated findings for hypertension. An uncertain finding is how poor sleep and hypertension connect with one another. It's a good topic to be aware of and hopefully more will be known with time. But we don't count those findings as building confidence on how to manage this condition. So that's a 0.
- Net, net, the Confidence Grade of 69 is based on (9 + 2 + 0) / 16 = 69%.
On the other end of the spectrum from hypertension is the current situation with COVID-19, which has a Confidence Grade of 28. While there are some knowns, there are a great deal of unknowns including how to treat COVID-19. Further, there are scores of rare diseases, which are not well-understood by medical experts and for which the management protocol is elusive. These are conditions that will have quite a low Confidence Grade because the Stoplight Ratings for these rare diseases will have a high incidence of yellow-rated findings, rather than green- or red-rated findings. In this case, those practitioners that have the most field experience in managing the condition likely have the best insights, albeit not fully codified and pressure-tested in research science.
How can you use these Confidence Grades?
By being an active shared decision maker, together with your doctor, you can use these Confidence Grades. For instance,
- If a condition has a high Confidence Grade, the information on Health Hippo is a very solid basis for you and your doctor to align as you determine your specific diagnosis and best care plan.
- And, for those conditions with medium Confidence Grades, you and your doctor can align on what is known and also problem-solve together on the uncertainties as they pertain to your health concerns.
- For a condition with a low Confidence Grade, it could make sense for you to obtain a second opinion from another healthcare provider, especially one who has significant field experience with the condition, in order to lower some of the uncertainty.