GRADE系统简介-Cochrane.ppt
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1、The GRADE ApproachThe GRADE Approachto Rating the Quality of Evidenceto Rating the Quality of EvidenceA Very Basic IntroductionA Very Basic IntroductionCochrane HIV/AIDS GroupCochrane HIV/AIDS GroupUniversity of California,San FranciscoUniversity of California,San FranciscoMarch 2010March 2010Backgr
2、ound:Too many systemsBackground:Too many systemsGuideline 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 ExampleExampleRecommendation for use of oral anticoagulation in patients wi
3、th Recommendation for use of oral anticoagulation in patients with atrial fibrillation and rheumatic mitral valve disease:atrial fibrillation and rheumatic mitral valve disease:ORGANIZATIONORGANIZATIONEVIDENCEEVIDENCERECOMMENDATIONRECOMMENDATIONAmerican Heart American Heart Association(AHA)Associati
4、on(AHA)B BClass IClass IAmerican College of American College of Clinical Pharmacy Clinical Pharmacy(ACCP)(ACCP)A A1 1Scottish Scottish Intercollegiate Intercollegiate Guidelines Network Guidelines Network(SIGN)(SIGN)IVIVC CThe same evidence different classificationThe same evidence different classif
5、icationGrading of Recommendations Grading of Recommendations Assessment,Development and Evaluation Assessment,Development and Evaluation(GRADE)(GRADE)A systematic method of assessing the quality of studies included in a systematic review and developing recommendations or guidelines based upon the ev
6、idenceGRADE Working Group formed in 2000Aim:to develop a common,transparent and sensible system for grading the quality of evidence and the strength of recommendationsGRADE uptakeGRADE uptakeAgency for Health Care Research and Quality(AHRQ)Allergic Rhinitis in Asthma Guidelines(ARIA)American College
7、 of Chest PhysiciansAmerican College of PhysiciansAmerican Thoracic SocietyBritish Medical JournalCanadian Agency for Drugs and Technology in HealthClinical EvidenceCochrane CollaborationEuropean Society of Thoracic SurgeonsInfectious Diseases Society of America(IDSA)National Institute Clinical Exce
8、llence(NICE)UpToDateWorld Health OrganizationMany other organizationsQuality of evidenceQuality 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-imp
9、ortant outcome.Authors of systematic reviews do not grade the overall quality of evidence across outcomes:that is the role of guideline developers.Determinants of qualityDeterminants of qualityStudy design is critical to judgments about the quality of evidence.Randomized trials provide,in general,fa
10、r stronger evidence than observational studiesRigorous observational studies provide stronger evidence than uncontrolled case series.In the GRADE approach to quality of evidence:In the GRADE approach to quality of evidence:Randomized trials without important limitations provide high quality evidence
11、 Observational studies without special strengths provide low quality evidence Limitations or special strengths can,however,modify the quality of the evidence of both randomized trials and observational studies.The GRADE system classifies the quality of The GRADE system classifies the quality of evid
12、ence in one of four grades:evidence in one of four grades:GRADEGRADEDEFINITIONDEFINITIONHighHighFurther research is very unlikely to change our Further research is very unlikely to change our confidence in the estimate of effect.confidence in the estimate of effect.ModerateModerateFurther research i
13、s likely to have an important impact on Further research is likely to have an important impact on our confidence in the estimate of effect and may change our confidence in the estimate of effect and may change the estimate.the estimate.LowLowFurther research is very likely to have an important Furth
14、er research is very likely to have an important impact on our confidence in the estimate of effect and is impact on our confidence in the estimate of effect and is likely to change the estimate.likely to change the estimate.Very LowVery Low Any estimate of effect is very uncertain.Any estimate of ef
15、fect is very uncertain.GRADEprofiler(GRADEpro)GRADEprofiler(GRADEpro)Software developed by the GRADE Working GroupSoftware developed by the GRADE Working GroupThree kinds of evidence tables:Three kinds of evidence tables:GRADE evidence profile Cochrane Summary of Findings(SoF)table Cochrane Overview
16、 of Reviews table SoF Table is the most useful for most Cochrane reviewsSoF Table is the most useful for most Cochrane reviewsEvidence Profile vs.Evidence Profile vs.Summary of Findings TableSummary of Findings TableGRADE Evidence profileGRADE Evidence profileParticularly useful for guideline develo
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