Centre for Clinical Practice, National Institute for Health and Clinical Excellence, City Tower, Piccadilly Plaza, Manchester M1 4BD, United Kingdom.
J Clin Epidemiol. 2013 Feb;66(2):124-31. doi: 10.1016/j.jclinepi.2011.12.007. Epub 2012 Mar 8.
Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a system for rating the confidence in estimates of effect and grading guideline recommendations. It promotes evaluation of the quality of the evidence for each outcome and an assessment of balance between desirable and undesirable outcomes leading to a judgment about the strength of the recommendation. In 2007, the National Institute for Health and Clinical Excellence began introducing GRADE across its clinical guideline program to enable separation of judgments about the evidence quality from judgments about the strength of the recommendation.
We describe the process of implementing GRADE across guidelines.
Use of GRADE has been positively received by both technical staff and guideline development group members.
A shift in thinking about confidence in the evidence was required leading to a more structured and transparent approach to decision making. Practical problems were also encountered; these have largely been resolved, but some areas require further work, including the application of imprecision and presenting results from analyses considering more than two alternative interventions. The use of GRADE for nonrandomized and diagnostic accuracy studies needs to be refined.
推荐评估、制定与评估分级（GRADE）是一种用于评估效果估计置信度和分级指南推荐的系统。它促进了对每个结局证据质量的评估，并对理想和不理想结局之间的平衡进行了评估，从而对推荐强度做出判断。2007 年，英国国家卫生与临床优化研究所开始在其临床指南项目中引入 GRADE，以实现对证据质量判断和推荐强度判断的分离。
我们描述了在指南中实施 GRADE 的过程。
GRADE 的使用得到了技术人员和指南制定小组成员的积极响应。
需要改变对证据可信度的思维方式，从而采用更具结构性和透明性的决策方法。实际中也遇到了一些问题；这些问题在很大程度上已经得到解决，但仍有一些领域需要进一步研究，包括不精确性的应用以及呈现考虑两种以上替代干预措施的分析结果。需要进一步完善 GRADE 在非随机和诊断准确性研究中的应用。
