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A practical approach to evidence grading.

N Greer1, G Mosser, G Logan

  • 1Institute for Clinical Systems Improvement, 8009 34th Ave South, Bloomington, MN 55425, USA. Nancy.Greer@icsi.org

The Joint Commission Journal on Quality Improvement
|January 6, 2001
PubMed
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The Institute for Clinical Systems Improvement developed a practical evidence grading system for clinicians. This system helps create defensible healthcare guidelines based on research evidence, improving patient care decisions.

Area of Science:

  • Clinical Practice Guidelines
  • Health Technology Assessment
  • Evidence-Based Medicine

Background:

  • The Institute for Clinical Systems Improvement (ICSI) is a collaboration of 17 Minnesota medical groups.
  • ICSI develops healthcare guidelines and technology assessment reports.
  • A system for grading evidence and conclusions was developed to ensure focus on underlying research.

Purpose of the Study:

  • To describe and evaluate the ICSI evidence and conclusion grading system.
  • To assess the system's utility for practicing clinicians in decision-making.
  • To determine the system's practicality and reliability in guideline development.

Main Methods:

  • The system utilizes a conclusion grading worksheet.
  • Worksheets involve stating conclusions, summarizing supporting/disputing research, assigning evidence classes/quality markers, and grading conclusions.

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  • The system was applied in developing over 40 guidelines and numerous technology assessment reports.

    • Main Results:

    • The evidence grading system has been successfully implemented in numerous clinical guidelines and technology assessments.
    • Practicing physicians have found the system practical and well-accepted.
    • The system aids drafting groups in focusing on evidence, and its outputs are valued by users.

    Conclusions:

    • The ICSI evidence grading system is effective in simplifying complex grading systems while providing defensible classifications.
    • The system successfully bases conclusions on the strength of underlying evidence.
    • While generally reliable and practical, the system requires epidemiological expertise and further rigorous testing for reliability.