Schünemann Holger J, Wiercioch Wojtek, Brozek Jan, Etxeandia-Ikobaltzeta Itziar, Mustafa Reem A, Manja Veena, Brignardello-Petersen Romina, Neumann Ignacio, Falavigna Maicon, Alhazzani Waleed, Santesso Nancy, Zhang Yuan, Meerpohl Jörg J, Morgan Rebecca L, Rochwerg Bram, Darzi Andrea, Rojas Maria Ximenas, Carrasco-Labra Alonso, Adi Yaser, AlRayees Zulfa, Riva John, Bollig Claudia, Moore Ainsley, Yepes-Nuñez Juan José, Cuello Carlos, Waziry Reem, Akl Elie A
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8N 4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8N 4K1, Canada.
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8N 4K1, Canada.
J Clin Epidemiol. 2017 Jan;81:101-110. doi: 10.1016/j.jclinepi.2016.09.009. Epub 2016 Oct 3.
Guideline developers can: (1) adopt existing recommendations from others; (2) adapt existing recommendations to their own context; or (3) create recommendations de novo. Monetary and nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes.
To describe a potentially efficient model for guideline production based on adoption, adaptation, and/or de novo development of recommendations utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks.
We applied the model in a new national guideline program producing 22 practice guidelines. We searched for relevant evidence that informs the direction and strength of a recommendation. We then produced GRADE EtDs for guideline panels to develop recommendations.
We produced a total of 80 EtD frameworks in approximately 4 months and 146 EtDs in approximately 6 months in two waves. Use of the EtD frameworks allowed panel members understand judgments of others about the criteria that bear on guideline recommendations and then make their own judgments about those criteria in a systematic approach.
The "GRADE-ADOLOPMENT" approach to guideline production combines adoption, adaptation, and, as needed, de novo development of recommendations. If developers of guidelines follow EtD criteria more widely and make their work publically available, this approach should prove even more useful.
指南制定者可以：（1）采用他人现有的建议；（2）使现有的建议适用于自身情况；或者（3）从头创建建议。货币和非货币资源、可信度、建议的最大接受度以及逻辑论证应指导方法和流程的选择。
描述一种潜在高效的指南制定模型，该模型基于采用、改编和/或从头制定建议，利用推荐分级评估、制定和评价（GRADE）证据到决策（EtD）框架。
我们将该模型应用于一个新的国家指南项目，该项目制定了22项实践指南。我们搜索了为建议的方向和力度提供依据的相关证据。然后，我们为指南小组制定了GRADE EtD，以制定建议。
我们分两波在大约4个月内共制定了80个EtD框架，在大约6个月内共制定了146个EtD。使用EtD框架使小组成员能够理解其他人对与指南建议相关标准的判断，然后以系统的方式对这些标准做出自己的判断。
指南制定的“GRADE-ADOLOPMENT”方法结合了建议的采用、改编以及必要时的从头制定。如果指南制定者更广泛地遵循EtD标准并公开其工作，这种方法将被证明更有用。
