The GRADE Evidence to Decision (EtD) framework for health system and public health decisions
Moberg, Jenny (Norwegian Institute of Public Health)
Oxman, Andrew D. (Norwegian Institute of Public Health (Bergen, Noruega))
Rosenbaum, Sarah (Norwegian Institute of Public Health)
Schünemann, Holger J. (McMaster University (Canadà))
Guyatt, Gordon (McMaster University (Canadà))
Flottorp, Signe (Norwegian Institute of Public Health (Bergen, Noruega))
Glenton, Claire (Norwegian Institute of Public Health (Bergen, Noruega))
Lewin, Simon (South African Medical Research Council)
Morelli, Angela (Norwegian Institute of Public Health (Bergen, Noruega))
Rada, Gabriel (Pontificia Universidad Católica de Chile)
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2018
Resum:	To describe a framework for people making and using evidence-informed health system and public health recommendations and decisions. We developed the GRADE Evidence to Decision (EtD) framework for health system and public health decisions as part of the DECIDE project, in which we simultaneously developed frameworks for these and other types of healthcare decisions, including clinical recommendations, coverage decisions and decisions about diagnostic tests. Building on GRADE EtD tables, we used an iterative approach, including brainstorming, consultation of the literature and with stakeholders, and an international survey of policy-makers. We applied the framework to diverse examples, conducted workshops and user testing with health system and public health guideline developers and policy-makers, and observed and tested its use in real-life guideline panels. All the GRADE EtD frameworks share the same basic structure, including sections for formulating the question, making an assessment and drawing conclusions. Criteria listed in the assessment section of the health system and public health framework cover the important factors for making these types of decisions; in addition to the effects and economic impact of an option, the priority of the problem, the impact of the option on equity, and its acceptability and feasibility are important considerations that can inform both whether and how to implement an option. Because health system and public health interventions are often complex, detailed implementation considerations should be made when making a decision. The certainty of the evidence is often low or very low, but decision-makers must still act. Monitoring and evaluation are therefore often important considerations for these types of decisions. We illustrate the different components of the EtD framework for health system and public health decisions by presenting their application in a framework adapted from a real-life guideline. This framework provides a structured and transparent approach to support policy-making informed by the best available research evidence, while making the basis for decisions accessible to those whom they will affect. The health system and public health EtD framework can also be used to facilitate dissemination of recommendations and enable decision-makers to adopt, and adapt, recommendations or decisions.
Ajuts:	Ministerio de Ciencia e Innovación CP09/00137
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Decision-making ; Evidence to decision ; GRADE ; Health systems ; Methodology ; Public health ; Recommendations
Publicat a:	Health Research Policy and Systems, Vol. 16 Núm. 1 (29 2018) , p. 45, ISSN 1478-4505

DOI: 10.1186/s12961-018-0320-2
PMID: 29843743

15 p, 797.9 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
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