Grading the strength of recommendations and the quality of underlying evidence enhances the usefulness of clinical practice guidelines (CPG). Although CPG have become a reality in healthcare, professional societies and other organizations until recently had not reached consensus about which of the numerous grading systems they should apply. The latter undermines the value of the grading exercise and the implementation of CPGs. In response to this dilemma, the international GRADE Working Group (the Grades of Recommendation, Assessment, Development and Evaluation Working Group) reviewed existing grading systems and has developed an approach that is useful for many guideline contexts.
The GRADE working group includes some of the worldwide leading clinical epidemiologists and other researchers with diverse backgrounds and skills representing the Cochrane Collaboration, the World Health Organization (WHO), the National Institutes of Health and Clinical Excellence (NICE) in the UK, and many other government and academic institutions. The GRADE system has been officially adopted by the World Health Organization (WHO). The GRADE working group now faces demands by various organizations for user-friendly software, tackling diagnostic questions, integration of evidence summaries into existing software and handbooks on how to apply the GRADE approach.
This proposal will respond to these demands addressing the following objectives:
1. Develop a user-friendly software application and detailed manual for the application of GRADE methodology
2. Prepare detailed instructions and manuscripts describing the GRADE approach and methodology for diagnostic guidelines and recommendations
3. Obtain feedback from field application of the products from objectives 1 and 2.
We will use electronic and direct communication tools to obtain feedback on the work we conduct as part of this proposal. We will also hold a GRADE working group meeting to complete these objectives.
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