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to reduce the confusion among guideline developers and users that results from the many existing, often scientifically outdated, grading systems by developing a simple, yet methodologically sound approach.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. ? ? ?
