Grading the strength of a body of evidence when assessing health care interventions: an EPC update
Grading the strength of a body of evidence when assessing health care interventions: an EPC update
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DOI：
10.1016/j.jclinepi.2014.11.023
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发表时间：
2015-11-01
影响因子：
7.2
通讯作者：
Chang, Stephanie
中科院分区：
文献类型：
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作者：
Berkman, Nancy D.;Lohr, Kathleen N.;Chang, Stephanie
目标：修订 2010 年关于对美国医疗保健研究和质量局 (AHRQ) 建立的循证实践中心 (EPC) 计划所产生的系统评价中药物、器械和其他预防和治疗干预措施有效性的证据强度 (SOB) 进行分级的指南。 研究设计和设置：跨 EPC 工作组审查了 SOE 分级的权威系统 [主要是建议评估、制定和评价分级的方法] （GRADE）工作组]并与 GRADE 和其他专家进行了广泛的讨论。结果：更新后的指南在概念上仍然与 GRADE 相似。评审员应针对每个主要结局的每个主要治疗比较分别评估 SOE。我们添加了报告偏倚作为必填领域，并保留了研究限制（偏倚风险）、一致性、直接性和精确性（以及三个可选领域）。其他指导包括对一致性、精确度和报告偏倚进行评分，通过随机对照试验和观察性研究对证据进行分级，评估单个研究证据，使用具有高偏倚风险的研究，以及以更清晰和透明的方式呈现研究结果。 SOB 分为高、中、低或不足，反映了评审者对特定治疗比较和结果的信心。 结论：没有一种单一的 SOE 分级方法适合所有评审，但报告摘要信息的更加一致和透明的方法将使评审对 AHRQ 工作旨在覆盖的广泛受众更有用。 EPC 工作组将考虑持续存在的挑战，并根据需要修改指南，涉及的问题包括将证据体中的试验和观察性研究相结合、加权领域以及将定性和定量综合相结合。 (C) 2015 Elsevier Inc. 保留所有权利。
Objectives: To revise 2010 guidance on grading the strength of evidence (SOB) of the effectiveness of drugs, devices, and other preventive and therapeutic interventions in systematic reviews produced by the Evidence-based Practice Center (EPC) program, established by the US Agency for Healthcare Research and Quality (AHRQ).Study Design and Setting: A cross-EPC working group reviewed authoritative systems for grading SOE [primarily the approach from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group] and conducted extensive discussions with GRADE and other experts.Results: Updated guidance continues to be conceptually similar to GRADE. Reviewers are to evaluate SOE separately for each major treatment comparison for each major outcome. We added reporting bias as a required domain and retained study limitations (risk of bias), consistency, directness, and precision (and three optional domains). Additional guidance covers scoring consistency, precision, and reporting bias, grading bodies of evidence with randomized controlled trials and observational studies, evaluating single study bodies of evidence, using studies with high risk of bias, and presenting findings with greater clarity and transparency. SOB is graded high, moderate, low, or insufficient, reflecting reviewers' confidence in the findings for a specific treatment comparison and outcome.Conclusion: No single approach for grading SOE suits all reviews, but a more consistent and transparent approach to reporting summary information will make reviews more useful to the broad range of audiences that AHRQ's work aims to reach. EPC working groups will consider ongoing challenges and modify guidance as needed, on issues such as combining trials and observational studies in bodies of evidence, weighting domains, and combining qualitative and quantitative syntheses. (C) 2015 Elsevier Inc. All rights reserved.