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The GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) is a method of assessing the certainty in evidence (also known as quality of evidence or confidence in effect estimates) and the strength of recommendations in health care.〔Schünemann HJ, Best D, Vist G, Oxman AD for the GRADE working group. Letters, numbers, symbols, and words: How best to communicate grades of evidence and recommendations? Canadian Medical Association Journal (CMAJ) 169(7);677-80, 2003.〕 It provides a structured and transparent evaluation of the importance of outcomes of alternative management strategies, acknowledgment of patients and the public values and preferences, and comprehensive criteria for downgrading and upgrading certainty in evidence. It has important implications for those summarizing evidence for systematic reviews, health technology assessments, and clinical practice guidelines as well as other decision makers. ==Background and history== Judgments about evidence and recommendations in healthcare are complex. Healthcare evidence and subsequent recommendations leave decision makers with differing degrees of certainty in that evidence. Sources of evidence range from small laboratory studies or case reports to well-designed large randomized controlled trials that have minimized bias to a great extent. The GRADE began in the year 2000 as a collaboration of methodologists, guideline developers, biostatisticians, clinicians, public health scientists and other interested members. GRADE developed and implemented a common, transparent and sensible approach to grading the quality of evidence (also known as certainty in evidence or confidence in effect estimates) and strength of recommendations in healthcare () The GRADE approach separates recommendations following from an evaluation of the evidence as strong or weak. A recommendations to use, or not use an option (e.g. an intervention), should be based on the trade-offs between desirable consequences of following a recommendation on the one hand, and undesirable consequences on the other (Table 2). If desirable consequences outweigh undesirable consequences, decision makers will recommend an option and vice versa. The uncertainty associated with the trade-off between the desirable and undesirable consequences will determine the strength of recommendations. The criteria that determine this balance of consequences are listed in Table 2. Furthermore, it provides decision-makers (e.g clinicians, other health care providers, patients and policy makers) with a guide to using those recommendations in clinical practice, public health and policy. To achieve simplicity, the GRADE approach classifies the quality of evidence in one of four levels—high, moderate, low, and very low (Table 1). Table 1. Quality of evidence and definitions ''(modified from Balshem et. al.)'' The GRADE working group has developed a software application that facilitates the use of the approach, allows the development of summary tables and contains the GRADE handbook. The software is free for non-profit organizations and is available at http://www.gradepro.org The GRADE approach to assess the certainty in evidence is widely applicable, including to questions about diagnosis,〔Schünemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist G, Williams J, Kunz R, Craig J, Montori V, Bossuyt P, Guyatt GH. GRADEing the quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 336;1106-1110, 2008〕〔Brozek JL, Akl EA, Jaeschke R, Lang DM, Bossuyt P, Glasziou P, Helfand M, Ueffing E, Alonso-Coello P, Meerpohl J, Phillips B, Horvath AR, Bousquet J, Guyatt GH, Schünemann HJ. Grading quality of evidence and strength of recommendations in clinical practice guidelines: part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies. Allergy 64(8): 1109-16, 2009.〕 prognosis,〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach」の詳細全文を読む スポンサード リンク
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