Evidence Based Medicine: Quality of Evidence and Evaluation Systems

Clinical care is increasingly informed by clinical practice guidelines. Well-formulated guidelines are transparent and actionable, and provide guidance through quality-rated evidence resulting into graded recommendations. In this chapter we discuss a methodologically rigorous yet simple rating system. Prior rating systems consisted of rigid, study type driven hierarchies. In contrast, the GRADE framework is outcomes-centric and explicit in its evidence rating criteria. GRADE also emphasizes that final guideline recommendations should not solely rely on the quality of evidence, but also on the balance between benefits and downsides, and consider patient values and preferences and resource use.