TY - JOUR
T1 - Grading the strength of a body of evidence when assessing health care interventions
T2 - An EPC update
AU - Berkman, Nancy D.
AU - Lohr, Kathleen N.
AU - Ansari, Mohammed T.
AU - Balk, Ethan M.
AU - Kane, Robert
AU - McDonagh, Marian
AU - Morton, Sally C.
AU - Viswanathan, Meera
AU - Bass, Eric B.
AU - Butler, Mary
AU - Gartlehner, Gerald
AU - Hartling, Lisa
AU - McPheeters, Melissa
AU - Morgan, Laura C.
AU - Reston, James
AU - Sista, Priyanka
AU - Whitlock, Evelyn
AU - Chang, Stephanie
N1 - Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/11
Y1 - 2015/11
N2 - Objectives To revise 2010 guidance on grading the strength of evidence (SOE) 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. SOE 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.
AB - Objectives To revise 2010 guidance on grading the strength of evidence (SOE) 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. SOE 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.
KW - Clinical practice guidelines
KW - Evidence-based practice
KW - Health care delivery
KW - Health policy
KW - Methods
KW - Minimally important differences
KW - Optimal information size
KW - Strength of evidence
KW - Systematic reviews
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U2 - 10.1016/j.jclinepi.2014.11.023
DO - 10.1016/j.jclinepi.2014.11.023
M3 - Article
C2 - 25721570
AN - SCOPUS:84945490686
SN - 0895-4356
VL - 68
SP - 1312
EP - 1324
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 11
ER -