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Grading the quality of evidence and strength of recommendation for health care recommendations (GRADE)

Final Activity Report Summary - GRADE (Grading the quality of evidence and strength of recommendation for health care recommendations)

Clinical practice guidelines are a key tool in providing best healthcare that should be informed by the best available evidence. However, guideline developers around the world are inconsistent in how they rate quality of evidence and grade strength of recommendations. As a result, guideline users face challenges in understanding the messages that grading systems try to communicate. The 'grading of recommendations assessment, development and evaluation' (GRADE) working group developed and approach that organisations around the world began.

The project had four main objectives
1. Develop a user-friendly software application and detailed manual for the application of GRADE methodology in clinical practice guideline projects and evidence grading exercises: This objective is fulfilled. We have completed the development of the software for interventions and are beginning the work on software for diagnostic management. The software is already widely used by international organisations such as the Cochrane Organisation. It is also used by the 'National institutes of health and clinical excellence' (NICE) in the UK and the WHO. A screenshot of the new version of the program is attached. We held several teleconference calls and meetings with members of the Cochrane Collaboration and obtained feedback at meetings
2. Prepare detailed instructions and manuscripts describing the GRADE approach and methodology for diagnosis: We have completed this objective and an article was published in the British Medical Journal. We have held a number of workshops working on this approach and refining it, including in Ottawa, Canada at the 'Canadian agency for drugs and technology in health' (CADTH), in Bilbao, Spain for the Basque guideline effort, at the 'Agency for health care and quality' in US (AHRQ), the Cochrane Colloquium in 2007, the 'Austrian health technology assessment Institute' and other locations around the world. Further workshops are planned for December 2007 at the. A series of 14 articles will be written for the Journal of Clinical Epidemiology (agreement with editors obtained) and published in 2009. While this latter series focuses on detailed instructions for guideline developers, the handbook listed in objective 1 includes these instructions in part.
3. Obtain feedback from field application of the products of objectives 1 and 2. We have completed a series of user testing and a study to obtain feedback on the program. This was provided by organisations such as CADTH, NICE, WHO and professional medical societies.
4. Conduct methodological projects related to the GRADE approach. We have begun an official project with the Cochrane Collaboration to measure time and effort involved to complete GRADE summary of findings tables.