Application of GRADE in Chinese clinical practice guidelines/expert consensus_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Qiao ^1,2 , REN Xiangying ³ , ZHANG Rong ^4,5 , LI Jiang ⁶ , YAN Siyu ^1,2 , WANG Yunyun ^1,2 ,  JIN Yinghui ^1,2

1. Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, P.R.China;
2. Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College, Wuhan University, Wuhan 430071, P.R.China;
3. School of Nursing and Health, Henan University, Kaifeng 475000, P.R.China;
4. Department of Neurotumor Disease Diagnosis and Treatment Center, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, P.R.China;
5. School of Health Sciences, Wuhan University, Wuhan 430071, P.R.China;
6. Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P.R.China;

Corresponding author：

JIN Yinghui, Email: jinyinghuiebm@163.com

Keywords：

Clinical practice guideline; Expert consensus; GRADE; Level of evidence; Strength of recommendation

DOI：

10.7507/1672-2531.202108187

Video：

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Objective To explore the methodological characteristics of Chinese clinical practice guidelines/expert consensus based on usage of GRADE. Methods CNKI, PubMed, WanFang Data databases, and Medlive.cn were electronically searched to collect Chinese clinical practice guidelines/expert consensus over the past 11 years from January 1^st 2010 to December 31^st 2020. Four reviewers independently extracted data according to the content of appraisal of guidelines quality evaluation tool AGREE Ⅱ. The clinical practice guidelines/expert consensus were divided into two groups based on whether GRADE was used or not. The changes and development of methodological quality in the past 11 years were explored between the two groups. Results In recent years, the number of clinical practice guidelines/expert consensus which used the GRADE in China had increased annually. The practice guidelines/expert consensus which did not use GRADE had lower methodology quality (P<0.01). Conclusions The use of GRADE in clinical practice guidelines/expert consensus requires improvement, and mastering GRADE methodology can effectively improve the methodological quality of the clinical practice guidelines/expert consensus.

Citation： HUANG Qiao, REN Xiangying, ZHANG Rong, LI Jiang, YAN Siyu, WANG Yunyun, JIN Yinghui. Application of GRADE in Chinese clinical practice guidelines/expert consensus. Chinese Journal of Evidence-Based Medicine, 2021, 21(12): 1457-1462. doi: 10.7507/1672-2531.202108187 Copy

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2.	赵世华. 科学认知临床实践指南和专家共识. 中华放射学杂志, 2021, 55(4): 340-342.
3.	Rosenfeld RM, Shiffman RN. Clinical practice guidelines: a manual for developing evidence-based guidelines to facilitate performance measurement and quality improvement. Otolaryngol Head Neck Surg, 2006, 135(4 Suppl): S1-S28.
4.	邓通, 汪洋, 黄笛, 等. 临床实践指南制订方法—GRADE方法理论篇. 中国循证心血管医学杂志, 2018, 10(12): 1441-1445.
5.	Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet, 2017, 390(10092): 415-423.
6.	陈昊, 王艳, 陈耀龙, 等. 从GRADE系统方法学看中医药临床证据体系的构建. 中华中医药杂志, 2017, 32(1): 25-28.
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11.	Werner SS, Binder N, Toews I, et al. Use of GRADE in evidence syntheses published in high-impact-factor nutrition journals: A methodological survey. J Clin Epidemiol, 2021, 135: 54-69.
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14.	Antoniou SA, Tsokani S, Mavridis D, et al. Guideline assessment project: filling the gap in surgical guidelines: quality improvement initiative by an international working group. Ann Surg, 2019, 269(4): 642-651.
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16.	靳英辉, 韩斐, 王明辉, 等. 临床实践指南制订方法—证据向推荐意见转化. 中国循证心血管医学杂志, 2018, 10(9): 1031-1038.
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19.	Welch VA, Akl EA, Guyatt G, et al. GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale. J Clin Epidemiol, 2017, 90: 59-67.
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21.	陈耀龙, 杨克虎, 姚亮, 等. GRADE系统方法学进展. 中国循证儿科杂志, 2013, 8(1): 64-65.
22.	周奇, 王玲, 杨楠, 等. 基于GRADE康复临床实践指南证据质量与推荐强度研究. 中国康复理论与实践, 2020, 26(2): 156-160.
23.	Agoritsas T, Merglen A, Heen AF, et al. UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey. BMJ Open, 2017, 7(11): e018593.
24.	Alexander PE, Brito JP, Neumann I, et al. World Health Organization strong recommendations based on low-quality evidence (study quality) are frequent and often inconsistent with GRADE guidance. J Clin Epidemiol, 2016, 72: 98-106.
25.	王子君, 姚亮, 刘练, 等. 推荐分级的评估, 制订与评价(GRADE)方法学家的培训与认证. 中国循证儿科杂志, 2017, 12(5): 388-391.

1. 王小钦, 王吉耀. 循证临床实践指南的制定和实施. 北京: 人民卫生出版社, 2015.
2. 赵世华. 科学认知临床实践指南和专家共识. 中华放射学杂志, 2021, 55(4): 340-342.
3. Rosenfeld RM, Shiffman RN. Clinical practice guidelines: a manual for developing evidence-based guidelines to facilitate performance measurement and quality improvement. Otolaryngol Head Neck Surg, 2006, 135(4 Suppl): S1-S28.
4. 邓通, 汪洋, 黄笛, 等. 临床实践指南制订方法—GRADE方法理论篇. 中国循证心血管医学杂志, 2018, 10(12): 1441-1445.
5. Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet, 2017, 390(10092): 415-423.
6. 陈昊, 王艳, 陈耀龙, 等. 从GRADE系统方法学看中医药临床证据体系的构建. 中华中医药杂志, 2017, 32(1): 25-28.
7. 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版). 护士进修杂志, 2015, 30(11): 964-967.
8. GRADE Working Group. GRADE home, 2021-03-01. Available at: http://www.gradeworkinggroup.org.
9. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394.
10. 陈耀龙, 姚亮, Susan Norris, 等. GRADE在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12): 1401-1404.
11. Werner SS, Binder N, Toews I, et al. Use of GRADE in evidence syntheses published in high-impact-factor nutrition journals: A methodological survey. J Clin Epidemiol, 2021, 135: 54-69.
12. Barker TH, Dias M, Stern C, et al. Guidelines rarely used GRADE and applied methods inconsistently: A methodological study of Australian guidelines. J Clin Epidemiol, 2021, 130: 125-134.
13. Wang X, Zhou Q, Chen Y, et al. Using RIGHT (Reporting Items for Practice Guidelines in Healthcare) to evaluate the reporting quality of WHO guidelines. Health Res Policy Syst, 2020, 18(1): 75.
14. Antoniou SA, Tsokani S, Mavridis D, et al. Guideline assessment project: filling the gap in surgical guidelines: quality improvement initiative by an international working group. Ann Surg, 2019, 269(4): 642-651.
15. 黄笛, 黄瑞秀, 郭晨煜, 等. 临床实践指南制定方法—证据分级与推荐强度. 中国循证心血管医学杂志, 2018, 10(7): 769-776.
16. 靳英辉, 韩斐, 王明辉, 等. 临床实践指南制订方法—证据向推荐意见转化. 中国循证心血管医学杂志, 2018, 10(9): 1031-1038.
17. Zhang Y, Coello PA, Brożek J, et al. Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach. Health Qual Life Outcomes, 2017, 15(1): 52.
18. 王子君, 王小琴, 姚亮, 等. GRADE对健康公平性的考虑. 中国循证医学杂志, 2018, 18(7): 746-752.
19. Welch VA, Akl EA, Guyatt G, et al. GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale. J Clin Epidemiol, 2017, 90: 59-67.
20. Welch VA, Akl EA, Pottie K, et al. GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. J Clin Epidemiol, 2017, 90: 76-83.
21. 陈耀龙, 杨克虎, 姚亮, 等. GRADE系统方法学进展. 中国循证儿科杂志, 2013, 8(1): 64-65.
22. 周奇, 王玲, 杨楠, 等. 基于GRADE康复临床实践指南证据质量与推荐强度研究. 中国康复理论与实践, 2020, 26(2): 156-160.
23. Agoritsas T, Merglen A, Heen AF, et al. UpToDate adherence to GRADE criteria for strong recommendations: an analytical survey. BMJ Open, 2017, 7(11): e018593.
24. Alexander PE, Brito JP, Neumann I, et al. World Health Organization strong recommendations based on low-quality evidence (study quality) are frequent and often inconsistent with GRADE guidance. J Clin Epidemiol, 2016, 72: 98-106.
25. 王子君, 姚亮, 刘练, 等. 推荐分级的评估, 制订与评价(GRADE)方法学家的培训与认证. 中国循证儿科杂志, 2017, 12(5): 388-391.

Chinese Journal of Evidence-Based Medicine

Application of GRADE in Chinese clinical practice guidelines/expert consensus

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