Das GRADE-System: Ein internationaler Ansatz zur Vereinheitlichung der Graduierung von Evidenz und Empfehlungen in Leitlinien

Zusammenfassung: Leitlinien haben sich für Ärzte und Patienten zu einer wichtigen Stütze bei diagnostischen und therapeutischen Entscheidungen entwickelt. Um die aktuell verfügbaren methodischen Konzepte der Leitlinienentwicklung zu harmonisieren und die große Heterogenität und oft mangelnde Transparenz existierender Systeme zu überwinden, hat die GRADE (Grading of Recommendations, Assessment, Development and Evaluation) Working Group, eine internationale Kollaboration von Leitlinienentwicklern, Klinikern und Methodikern, die vorhandenen Konzepte weiterentwickelt. Zentrale Bestandteile des GRADE-Systems sind die Unterscheidung zwischen der Qualität der Evidenz und der Stärke einer Empfehlung, die gleichzeitige Betrachtung von Nutzen und Schaden einer Intervention, die Fokussierung auf patientenrelevante Endpunkte, die Abbildung von inhärenten Wertvorstellungen einer Empfehlung und die Integration von Überlegungen zum Ressourcenverbrauch. Unter Berücksichtigung dieser Kriterien werden mit dem GRADE-System starke und abgeschwächte Empfehlungen abgegeben. International befürworten zahlreiche Leitlinienorganisationen und medizinische Fachgesellschaften das System und haben es für die Erstellung der eigenen Leitlinien übernomme

From evidence to action. Understanding clinical practice guidelines.

Good guidelines will help us to take evidence into practice. In a survey among Dutch orthopedic surgeons, development and use of evidence-based guidelines was perceived as one of the best ways of moving from opinion-based to evidence-based orthopedic practice. The increasing number of guidelines means that knowing how to make a critical appraisal of guidelines is now a key part of every surgeon's life. This is particularly true because guidelines use varying systems to judge the quality of evidence and the strength of recommendations. In this manuscript we discuss what a guideline is, where we can find guidelines, how to evaluate the quality of guidelines, and finally provide an example on the different steps of guideline development. Thus, we show that good guidelines are a summary of the best available evidence and that they provide a graded recommendation to help surgeons in evidence-based practic

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma a

Bringing two worlds closer together: a critical analysis of an integrated approach to guideline development and quality assurance schemes

Contains fulltext : 231643.pdf (publisher's version ) (Open Access

Guidelines rarely used GRADE and applied methods inconsistently: a methodological study of Australian guidelines

Objectives: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is accepted methodology to assess the certainty of the evidence included in systematic reviews and clinical practice guidelines. The GRADE approach is endorsed globally, in Australia, the National Health and Medical Research Council advocated for the use of the GRADE approach in 2011. The purpose of this methodological review was to assess how GRADE has been adopted for Australian practice guidelines. Study Design and Setting: This methodological review searched of the National Health and Medical Research Council Clinical Practice Guidelines Portal from 2011 to 2018, in an effort to retrieve all practice guidelines available via this medium. Results: 240 guidelines were retrieved authored by 51 different organizations. 15 guidelines followed GRADE methodology. Application of GRADE methods varied between guidelines, some misreported and altered aspects of the GRADE process. Guidelines that closely adhered to the guidance from the GRADE Working Group scored higher in domain 3 (rigor of development) of the Appraisal of Guidelines for Research and Evaluation II tool, indicating a positive linear relationship between GRADE adherence and rigor of development scores. Conclusion: The results of our project suggest that the use of GRADE in Australian guidelines is increasing, however, strategies to increase uptake and reporting within the guideline community need to be explored.Timothy Hugh Barker, Mafalda Dias, Cindy Stern, Kylie Porritt, Rick Wiechula, Edoardo Aromataris ... et al

Approaches of integrating the development of guidelines and quality indicators: a systematic review

Contains fulltext : 225833.pdf (publisher's version ) (Open Access)BACKGROUND: Guidelines and quality indicators (for example as part of a quality assurance scheme) aim to improve health care delivery and health outcomes. Ideally, the development of quality indicators should be grounded in evidence-based, trustworthy guideline recommendations. However, anecdotally, guidelines and quality assurance schemes are developed independently, by different groups of experts who employ different methodologies. We conducted an extension and update of a previous systematic review to identify, describe and evaluate approaches to the integrated development of guidelines and related quality indicators. METHODS: On May 24th, 2019 we searched in Medline, Embase and CINAHL and included studies if they reported a methodological approach to guideline-based quality indicator development and were published in English, French, or German. RESULTS: Out of 16,034 identified records, we included 17 articles that described a method to integrate guideline recommendations development and quality indicator development. Added to the 13 method articles from original systematic review we included a total 30 method articles. We did not find any evaluation studies. In most approaches, guidelines were a source of evidence to inform the quality indicator development. The criteria to select recommendations (e.g. level of evidence or strength of the recommendation) and to generate, select and assess quality indicators varied widely. We found methodological approaches that linked guidelines and quality indicator development explicitly, however none of the articles reported a conceptual framework that fully integrated quality indicator development into the guideline process or where quality indicator development was part of the question formulation for developing the guideline recommendations. CONCLUSIONS: In our systematic review we found approaches which explicitly linked guidelines with quality indicator development, nevertheless none of the articles reported a comprehensive and well-defined conceptual framework which integrated quality indicator development fully into the guideline development process