GRADE系统简介-Cochraneppt参考课件.ppt

* * The GRADE Approachto Rating the Quality of EvidenceA Very Basic Introduction Cochrane HIV/AIDS Group University of California, San Francisco March 2010 * Background: Too many systems Guideline developers use a bewildering variety of systems to rate the quality of the evidence underlying their recommendations. As a result, guideline users have faced challenges * Example Recommendation for use of oral anticoagulation in patients with atrial fibrillation and rheumatic mitral valve disease: ORGANIZATION EVIDENCE RECOMMENDATION American Heart Association (AHA) B Class I American College of Clinical Pharmacy (ACCP) A 1 Scottish Intercollegiate Guidelines Network (SIGN) IV C The same evidence – different classification * Grading of Recommendations Assessment, Development and Evaluation (GRADE) A systematic method of assessing the quality of studies included in a systematic review and developing recommendations or guidelines based upon the evidence GRADE Working Group formed in 2000 Aim: to develop a common, transparent and sensible system for grading the quality of evidence and the strength of recommendations * GRADE uptake Agency for Health Care Research and Quality (AHRQ) Allergic Rhinitis in Asthma Guidelines (ARIA) American College of Chest Physicians American College of Physicians American Thoracic Society British Medical Journal Canadian Agency for Drugs and Technology in Health Clinical Evidence Cochrane Collaboration European Society of Thoracic Surgeons Infectious Diseases Society of America (IDSA) National Institute Clinical Excellence (NICE) UpToDate World Health Organization Many other organizations * Quality of evidence “The extent to which one can be confident that an estimate of effect or association is correct.” Authors of systematic reviews grade quality of a body of evidence separately for each patient-important outcome. Authors of systematic reviews do not grade the overall quality of evidence across outcomes: that is the role of guideline d