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

描述：背景和意义：人们越来越认识到确保临床护理质量的必要性。临床实践指南的分级证据和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能有多大的信心。职级工作组旨在通过开发一种简单但在方法上合理的方法，减少准则制定者和用户因许多现有的、往往在科学上过时的评分系统而造成的困惑。评级倡议的意义包括：1)评级有助于证据转换，因为每个级别的建议都明确定义了预期的临床实践影响；2)评级方法说明了在对建议进行评级时，患者的价值和偏好如何发挥重要作用；3)对于医疗保健管理者和政策制定者，评级可以帮助定义对绩效衡量证据进行评级时的阈值水平，特别是在考虑按绩效付费模式时；4)对于研究人员和研究资助机构，评级原则可以在审查拟议的研究计划时指导预期的证据质量。具体目标：拟议的等级研讨会的目标是在指南开发者/系统审查者中达成共识：与正在使用/考虑使用等级系统的美国组织(例如，医学会、美国预防服务工作组、AHRQ资助的循证实践中心)讨论等级系统；进一步开发资源利用的证据质量分级方法；讨论和定义等级证据档案的基于网络的数据存储库的功能。以前的工作：分级制度是基于对证据质量的顺序评估，然后是对利弊之间的平衡评估，以及随后对建议力度的判断。以前的会议都是在讨论审查和准则的多个实例以及基于这些实例的证据简介的基础上进行的。通过试点，验证了该方案的可行性。还创建了一个评分软件工具和一个网络存在。研讨会的计划和预期的产品：我们申请资金支持一个为期两天的研讨会，该研讨会将由该职等工作组成员参加。研讨会计划于2007年12月7日和8日(星期五和星期六)在马里兰州罗克维尔华盛顿特区附近的AHRQ会议设施举行。预期产品：1)研讨会将使使用或考虑在讨论中使用等级的美国主要组织参与讨论，并促进指南开发者、EPC和其他使用等级系统的机构之间的协调；我们将就进一步发展的关键领域达成共识；2)就如何对与成本(资源利用)有关的证据进行评级的建议出版；3)最终确定等级手册中关于纳入成本的章节的内容；4)等级证据档案的网络数据存储库。1临床实践指南的分级证据和建议有助于决策者实施循证实践。评分工作组旨在减少准则制定者和用户之间的困惑，因为许多现有的、往往在科学上过时的评分系统造成了混乱。研讨会将使使用或考虑使用评分系统的美国主要组织参与讨论，并促进指南制定者、EPC和其他使用评分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to reduce the confusion among guideline developers and users that results from the many existing, often scientifically outdated, grading systems by developing a simple, yet methodologically sound approach.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.