TY - JOUR
T1 - AHRQ Series Paper 5
T2 - Grading the strength of a body of evidence when comparing medical interventions-Agency for Healthcare Research and Quality and the Effective Health-Care Program
AU - Owens, Douglas K.
AU - Lohr, Kathleen N.
AU - Atkins, David
AU - Treadwell, Jonathan R.
AU - Reston, James T.
AU - Bass, Eric B.
AU - Chang, Stephanie
AU - Helfand, Mark
N1 - Funding Information:
This research was funded through contracts from the AHRQ to the following EPCs: ECRI Institute (290-02-0019); Johns Hopkins University (290-02-0018), Oregon Health & Science University (290-02-0009); RTI International (290-02-0016); and Stanford University (290-02-0017). The opinions expressed here are those of the authors and do not necessarily represent the views of the AHRQ, the Department of Health and Human Services, or the Department of Veterans Affairs. The authors thank Valerie King, MD, MPH, of the John M. Eisenberg Center at Oregon Health & Science University for her insightful comments on an earlier draft; and Loraine Monroe, of RTI International, for superior assistance with manuscript preparation. We thank Gordon Guyatt, Holger Schünemann, and the members of the GRADE working group for their work on rating quality of evidence, for very helpful discussions about our approach, and for comments on the manuscript.
PY - 2010/5
Y1 - 2010/5
N2 - Objective: To establish guidance on grading strength of evidence for the Evidence-based Practice Center (EPC) program of the U.S. Agency for Healthcare Research and Quality. Study Design and Setting: Authors reviewed authoritative systems for grading strength of evidence, identified domains and methods that should be considered when grading bodies of evidence in systematic reviews, considered public comments on an earlier draft, and discussed the approach with representatives of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. Results: The EPC approach is conceptually similar to the GRADE system of evidence rating; it requires assessment of four domains: risk of bias, consistency, directness, and precision. Additional domains to be used when appropriate include dose-response association, presence of confounders that would diminish an observed effect, strength of association, and publication bias. Strength of evidence receives a single grade: high, moderate, low, or insufficient. We give definitions, examples, mechanisms for scoring domains, and an approach for assigning strength of evidence. Conclusion: EPCs should grade strength of evidence separately for each major outcome and, for comparative effectiveness reviews, all major comparisons. We will collaborate with the GRADE group to address ongoing challenges in assessing the strength of evidence.
AB - Objective: To establish guidance on grading strength of evidence for the Evidence-based Practice Center (EPC) program of the U.S. Agency for Healthcare Research and Quality. Study Design and Setting: Authors reviewed authoritative systems for grading strength of evidence, identified domains and methods that should be considered when grading bodies of evidence in systematic reviews, considered public comments on an earlier draft, and discussed the approach with representatives of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. Results: The EPC approach is conceptually similar to the GRADE system of evidence rating; it requires assessment of four domains: risk of bias, consistency, directness, and precision. Additional domains to be used when appropriate include dose-response association, presence of confounders that would diminish an observed effect, strength of association, and publication bias. Strength of evidence receives a single grade: high, moderate, low, or insufficient. We give definitions, examples, mechanisms for scoring domains, and an approach for assigning strength of evidence. Conclusion: EPCs should grade strength of evidence separately for each major outcome and, for comparative effectiveness reviews, all major comparisons. We will collaborate with the GRADE group to address ongoing challenges in assessing the strength of evidence.
KW - Comparative effectiveness
KW - Evidence-based medicine
KW - Methods
KW - Strength of evidence
KW - Systematic reviews
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U2 - 10.1016/j.jclinepi.2009.03.009
DO - 10.1016/j.jclinepi.2009.03.009
M3 - Article
C2 - 19595577
AN - SCOPUS:77949609822
SN - 0895-4356
VL - 63
SP - 513
EP - 523
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 5
ER -