GRADE - Moving Towards a Consensus on a Consistent Approach to Grading Evidence

背景和意义：人们越来越意识到确保临床护理质量的必要性。分级证据和临床实践指南的建议有助于决策者实施循证实践。然而，用户需要知道他们对这些推荐有多大的信心。GRADE工作组旨在通过开发一种简单但在方法上合理的方法，减少指南开发者和用户之间因许多现有的、通常在科学上过时的分级系统而产生的困惑。GRADE倡议的意义包括：1)GRADE促进了证据转化，因为每个推荐级别的预期临床实践影响都是明确定义的；2) GRADE方法说明了患者的价值观和偏好如何在分级建议中发挥重要作用；3)对于卫生保健管理人员和政策制定者来说，GRADE可以帮助确定绩效指标证据分级时的阈值水平，特别是在考虑绩效付费模式时；4)对于研究人员和研究资助机构，GRADE原则可以在审查拟议的研究计划时对预期的证据质量提供指导。具体目标：拟议的GRADE研讨会的目标是在指南制定者/系统审稿人之间达成共识：与正在使用/考虑使用GRADE系统的美国组织（例如，医学协会、美国预防服务工作组、ahrq资助的循证实践中心）讨论GRADE系统；进一步制定资源利用证据质量分级方法；讨论并定义基于web的GRADE证据文件数据存储库的功能。以前的工作：GRADE系统是基于对证据质量的连续评估，然后评估利弊之间的平衡，然后对建议的强度进行判断。以前的会议建立在对多个审查和指南示例以及基于这些示例的证据概况的讨论之上。已通过试点测试了可行性。还创建了一个评分软件工具和一个网站。计划研讨会和预期产品：我们请求资金支持为期两天的研讨会，由GRADE工作组成员参加。该研讨会计划于2007年12月7日至8日星期五和星期六在华盛顿特区附近的马里兰州罗克维尔举行。预期成果：1)研讨会将邀请使用或考虑使用GRADE的美国主要组织参与讨论，并促进指南制定者、EPC和其他使用评分系统的组织之间的协调；我们将在重点发展领域达成共识；2)发布关于如何对与成本（资源利用）相关的证据进行分级的建议3)最终确定grade手册中有关纳入成本的部分的内容；4)基于Web的GRADE证据文件数据存储库。1临床实践指南的证据分级和建议有助于决策者实施循证实践。GRADE工作组的目标是减少指南开发者和用户之间的混乱，这种混乱源于许多现有的、通常在科学上已经过时的评分系统。研讨会将邀请使用或考虑使用GRADE系统的美国主要组织参与讨论，并促进指南制定者、EPC和其他使用分级系统的组织之间的协调。

DESCRIPTION: Background and significance: There is increased awareness of the necessity of ensuring the quality of clinical care. Grading evidence and recommendations of clinical practice guidelines help decision- makers implement evidence-based practices. However, users need to know how much confidence they can place in those recommendations. The GRADE Working Group aims to reduce the confusion among guideline developers and users that results from the many existing, often scientifically outdated, grading systems by developing a simple, yet methodologically sound approach. The significance of the GRADE initiative includes: 1) GRADE facilitates evidence translation, since expected clinical practice implications for each level of recommendation are explicitly defined; 2) The GRADE approach illustrates how patient values and preferences play an important role when grading recommendations; 3) For health care managers and policy makers, GRADE can help define threshold levels when grading the evidence of performance measures, particularly when pay-for-performance models are considered; 4) For researchers and research funding agencies, GRADE principles may give guidance on the expected quality of evidence when reviewing proposed research plans. Specific Aims: The goal of the proposed GRADE workshop is to reach a consensus among guideline developers/systematic reviewers: Discuss the GRADE system with organizations in the U.S. that are using / considering its use (e.g., medical societies, the U.S. Preventive Services Task Force, the AHRQ-funded Evidence-based Practice Centers); further develop methods for grading the quality of evidence of resource utilization; discuss and define functionally of a web based data repository for GRADE evidence profiles. Previous work: The GRADE system is based on a sequential assessment of the quality of evidence, followed by assessment of the balance between benefits versus downsides and subsequent judgment about the strength of recommendations. Previous meetings have built on discussions of multiple examples of reviews and guidelines, and evidence profiles based on these. Feasibility has been tested through piloting. A grading software tool and a web presence have also been created. Plan for the workshop and expected products: We request funding to support a two-day workshop to be attended by members of the GRADE working group. The workshop is planned to be held in Rockville, MD near Washington, DC at the conference facilities of the AHRQ on Friday and Saturday, December 7/8, 2007. Expected Products: 1) The workshop will engage key U.S. organizations using or considering using GRADE in discussion and promote harmonization amongst guideline developers, EPC's and others using grading systems; and we will reach a consensus on key areas for further development; 2) Publication of recommendations on how to grade evidence related to costs (resource utilization) 3) Finalize the content of the sections of the GRADE handbook concerning the inclusion of costs; 4) Web based data repository for GRADE evidence profiles. 1 Grading evidence and recommendations of clinical practice guidelines help decision-makers implement evidence-based practices. The GRADE Working Group aims to reduce the confusion among guideline developers and users that results from the many existing, often scientifically outdated, grading systems. The workshop will engage key U.S. organizations using or considering using the GRADE system in discussion and promote harmonization amongst guideline developers, EPC's and others using grading systems.