Core GRADE 1: overview of the Core GRADE approach
This first article in a seven part series presents an overview of the essential elements of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach that has proved extremely useful in systematic reviews, health technology assessment reports, and clinical practice guidelines. GRADE guidance has appeared in many articles dealing with both core issues and more specialised and complex guidance, and it has evolved over time. This series of articles presents GRADE essentials, Core GRADE, focusing on the core judgments necessary to summarise the comparative evidence about alternative care options and to make recommendations that apply to the care of individual patients. This article presents detailed guidance on formulating questions using the PICO (population, intervention, comparison, outcome) structure, and refining the question considering possible differences in relative and absolute effects across patient groups. The article then provides an overview of the remainder of the Core GRADE approach, including decisions about the certainty of the evidence and considerations in moving from evidence to guidance and recommendations.
Authors
- Arnav Agarwal (ORCID: https://orcid.org/0000-0001-5780-725X)
- Romina Brignardello‐Petersen (ORCID: https://orcid.org/0000-0002-6010-9900)
- Thomas Agoritsas (ORCID: https://orcid.org/0000-0002-6182-9969)
- Manya Prasad (ORCID: https://orcid.org/0000-0002-1239-0013)
- Per Olav Vandvik (ORCID: https://orcid.org/0000-0001-8958-2710)
- Roman Jaeschke (ORCID: https://orcid.org/0000-0003-1023-3740)
- Gordon Guyatt (ORCID: https://orcid.org/0000-0003-2352-5718)
- Monica Hultcrantz (ORCID: https://orcid.org/0000-0002-5140-4289)
- Alfonso Iorio (ORCID: https://orcid.org/0000-0002-3331-8766)
- Hans de Beer
- Jamie Rylance (ORCID: https://orcid.org/0000-0002-2323-3611)
- Rohan D’Souza (ORCID: https://orcid.org/0000-0002-4049-2017)
- Mohammad Hassan Murad (ORCID: https://orcid.org/0000-0001-5502-5975)
- Kameshwar Prasad (ORCID: https://orcid.org/0000-0001-9673-2473)
- Linan Zeng (ORCID: https://orcid.org/0000-0001-9892-2000)
- Farid Foroutan (ORCID: https://orcid.org/0000-0002-1029-1812)
- Reem A. Mustafa (ORCID: https://orcid.org/0000-0002-2091-0875)
- Stefan Schandelmaier (ORCID: https://orcid.org/0000-0002-8429-0337)
- Derek K. Chu (ORCID: https://orcid.org/0000-0001-8269-4496)
- David M. Rind
- Liang Yao (ORCID: https://orcid.org/0000-0003-4068-3136)
- Sameer Parpia
- Víctor M. Montori (ORCID: https://orcid.org/0000-0003-0595-2898)
- Prashanti Eachempati
Institutions
- Beth Israel Deaconess Medical Center (US)
- Mayo Clinic (US)
- Nanyang Technological University (SG)
- University of Oslo (NO)
- University of Basel (CH)
- University of Toronto (CA)
- Liverpool School of Tropical Medicine (GB)
- Sichuan University (CN)
- University College Cork (IE)
- West China Medical Center of Sichuan University (CN)
- University Hospital of Basel (CH)
- Karolinska Institutet (SE)
- New India Foundation (IN)
- West China Second University Hospital of Sichuan University (CN)
- Ted Rogers Centre for Heart Research (CA)
- China First Heavy Industries (China) (CN)
- Institute for Clinical and Economic Review (US)
- University Hospital of Geneva (CH)
- Art Innovation (Netherlands) (NL)
- Manipal University College Malaysia (MY)
- Institute of Liver and Biliary Sciences (IN)
- Mayo Clinic in Arizona (US)
- University of Kansas Medical Center (US)
- Stockholm Health Care Services (SE)
- Mayo Clinic in Florida (US)
- Impact (CA)
- Geneva College (US)
- All India Institute of Medical Sciences (IN)
- University of Pecs (HU)
- University of Plymouth (GB)
- McMaster University (CA)
Publication Details
- Journal
- BMJ
- Published
- 2025-04-22
- DOI
- https://doi.org/10.1136/bmj-2024-081903
- Citations
- 73
- Primary Topic
- Health Systems, Economic Evaluations, Quality of Life
- Type
- article
- Field-Weighted Citation Impact
- 228.57