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Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions
Philipp Dahm1, Andrew D Oxman2, Benjamin Djulbegovic3
1Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Urology, University of Minnesota, Minneapolis, MN, USA.
Journal of Clinical Epidemiology
|April 6, 2017
Summary
Stakeholders successfully used an evidence-to-decision framework for health coverage decisions. This process, based on Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, improved transparency and accountability in complex decision-making.
Area of Science:
- Health policy research
- Decision science
- Evidence-based practice
Background:
- Coverage decisions are complex, involving multiple factors.
- A structured, transparent process can enhance decision-making and accountability.
Purpose of the Study:
- To survey US stakeholders on current coverage decision-making approaches.
- To test an evidence-to-decision (EtD) framework using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria for coverage decisions.
Main Methods:
- Survey of 19 US stakeholders on their organizations' coverage decision processes.
- Workshop involving 42 international and US participants to apply the EtD framework to case studies.
Main Results:
- Most organizations (93%) use systematic reviews; few (14%) conduct their own evidence synthesis.
- Majority (64%) assess evidence certainty; most (93%) do not formally consider resource use.
- Stakeholders successfully applied the EtD framework, highlighting US-specific contextual factors and data needs for patient subgroups.
Conclusions:
- Stakeholders affirmed the value of the EtD framework for coverage decisions.
- Participant feedback informed the revision of the EtD framework.
- A revised EtD framework is now publicly available at http://gradepro.org/.