Evidence-based? What’s the GRADE?


GRADE Working Group

Personally, I have a love/hate relationship with healthcare’s dependence on grading systems, kitemarks, seals of approval, etcetera, especially in the realm of websites and information for patients or general health literacy. It is rather a different matter when it comes to information for clinicians and healthcare providers (HCPs). There, we typically depend on the peer-review process to give clinicians confidence in the information on which they base their clinical decisions for patient care. Retraction Watch and others have made it clear that simply being published is no longer (if it ever was) an assurance of quality and dependability of healthcare information. As long as I’ve been working as a medical librarian, I’ve been hearing from med school faculty that their students don’t do the best job of critically appraising the medical literature. I suspect this is something that medical faculty have said for many generations, and that it is nothing new. Still, it is welcome to find tools and training to help improve awareness of the possible weaknesses of the literature and how to assess quality.

During some recent excellent and thought provoking conversations on the Evidence-Based Health list, GRADE was brought up yet again by Per Olav Vandvik. There have been several conversations about GRADE in this group, but I thought perhaps some of the readers of this blog might not be aware of it yet. Here’s a brief intro.

GRADE stands for “Grading of Recommendations Assessment, Development and Evaluation.” GRADE Working Group is the managing organization. I like their back history: “The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) Working Group began in the year 2000 as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health care.”

GRADE Working Group: http://www.gradeworkinggroup.org/index.htm

Playlist of Presentations on GRADE by the American Thoracic Society:
http://www.youtube.com/playlist?list=PLv3ASQRBkH-NMKAbMYoDIsWuGMF8fUrVL

Free software to support the GRADE process.

Cochrane: RevMan: GRADEpro: http://ims.cochrane.org/revman/gradepro

UpToDate GRADE Tutorial: http://www.uptodate.com/home/grading-tutorial

20-part article series in Journal of Clinical Epidemiology explaining GRADE. These articles focus on:
– Rating the quality of evidence
– Summarizing the evidence
– Diagnostic tests
– Making recommendations
– GRADE and observational studies

GRADE guidelines – best practices using the GRADE framework: http://www.gradeworkinggroup.org/publications/JCE_series.htm

New York Academy of Medicine is having a training session on GRADE this coming August. You can find more information here.

Teaching Evidence Assimilation for Collaborative Healthcare: http://www.nyam.org/fellows-members/ebhc/
PDF on GRADE section of the course: http://www.nyam.org/fellows-members/docs/2013-More-Information-on-Level-2-GRADE.pdf

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