gdg meeting wednesday november 9, 2011 9:30 – 11:30 am
DESCRIPTION
GDG Meeting Wednesday November 9, 2011 9:30 – 11:30 am. Agenda. Objectives. Confirm outcomes for analytic framework Review Guideline Development Process Review rationale and purpose of GRADE Review a sample GRADE table to ensure everyone is comfortable using them. GRADE: An Overview. - PowerPoint PPT PresentationTRANSCRIPT
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GDG Meeting
Wednesday November 9, 2011 9:30 – 11:30 am
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Time Agenda Lead
9:30 - 9:35 Review objectives for the teleconference Jess Rogers
9:35 - 9:45 Business rising from previous meeting:• Conflict of interest• Analytic framework• Literature research and review
Jess Rogers
9:45 - 10:00 Review of guideline methods Jess Rogers
10:00 - 10:20 Confirming Outcomes Valerie Palda
10:20 - 11:15 GRADE:• What does GRADE offer?• Review GRADE process/methodology• Walk though GRADE tables• How do you combine evidence?
Valerie Palda Dave Hallett
11:15 - 11:30 • Questions• Overview of training session agenda Dec 6-7• Action items
All
Agenda
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Objectives Confirm outcomes for analytic framework Review Guideline Development Process Review rationale and purpose of GRADE Review a sample GRADE table to ensure
everyone is comfortable using them
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GRADE: An OverviewGrading of RecommendationsAssessment, Development and
Evaluation
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Agenda What is GRADE? Importance of Evidence Determining Quality of Evidence Methods for Summarizing Evidence
• Evidence Profile Tables• Summary of Findings Tables
Determining Strength of Recommendations
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What is GRADE? A transparent and structured process for
developing and presenting evidence summaries for systematic reviews and guidelines in health care and for carrying out the steps involved in developing recommendations.
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The GRADE Approach Considers
• All factors to determine how confident we are in the results (quality of evidence)
• The evidence for each outcome• Magnitude of the effect
Ensures• Systematic process• Transparency
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Importance of EvidenceWhen making guideline recommendations: The quality of evidence reflects the extent to
which our confidence in an estimate of the effect is adequate to support a particular recommendation.
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Quality of the Body of Evidence
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Determining Quality RCTs start (high) Observational studies start at (low)
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Determining Quality
5 factors that can lower quality1. Limitations in detailed design and execution (risk
of bias criteria)2. Inconsistency (or heterogeneity)3. Indirectness (PICO and applicability)4. Imprecision (number of events and confidence
intervals)5. Publication bias
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Summarizing Evidence Evidence Profiles and Summary of Findings
Tables• An EP includes a detailed quality assessment in
addition to a SoFs. • The SoF table includes an assessment of the
quality of evidence for each outcome but not the detailed judgments on which that assessment is based.
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Evidence Profile Table
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Summary of Findings Table
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Determining Strength of Recommendations
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4 key Factors Influence the Strength of a Recommendation
1. Quality of the evidence The higher the quality of evidence, the more likely is a strong
recommendation.2. Balance between desirable and undesirable effects The larger the difference between the desirable and undesirable
consequences, the more likely a strong recommendation warranted. The smaller the net benefit and the lower certainty for that benefit, the more likely weak recommendation warranted.
3. Values and preferences The greater the variability in values and preferences, or uncertainty in
values and preferences, the more likely weak recommendation warranted.
4. Costs (resource allocation) The higher the costs of an intervention – that is, the more resources
consumed – the less likely is a strong recommendation warranted
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