GRADE
GRADE is a system that helps experts judge how confident we can be in research evidence and how strong health recommendations should be. It is used by many health organizations around the world.
At a glance
Use when
Developing clinical guidelines, conducting health technology assessments, or evaluating evidence for decision-making in healthcare.
Avoid when
Rapid assessments with limited resources or when no comparative evidence is available.
Inputs
Evidence from clinical studies (e.g., RCTs, observational studies), outcome data, risk of bias assessments, inconsistency and imprecision evaluations, values and preferences, cost data.
Outputs
Rated quality of evidence (high, moderate, low, very low) and strength of recommendations (strong or conditional).
How it works
The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system provides a structured framework for assessing the quality of evidence and the strength of recommendations in clinical guidelines and health technology assessments. It considers study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias when rating evidence quality, and factors such as balance of benefits and harms, certainty of evidence, values and preferences, and resource implications when determining recommendation strength.
- HTA domains
- Clinical Effectiveness, Costs & Economic Evaluation, Safety
- Assumptions
- Evidence quality can be systematically evaluated across domains; recommendation strength should reflect not only evidence quality but also other ethical and practical considerations.
- Strengths
- Transparent, systematic, widely adopted, applicable across diverse healthcare questions, incorporates patient values and resource use.
- Limitations
- Can be time-consuming; requires training; subjective judgments may vary between assessors; may not fully capture complexity in some contexts.
- Also known as
- Grading of Recommendations Assessment, Development and Evaluation
Questions this answers
- › How high is the quality of the evidence supporting a health intervention?
- › How strong should a recommendation for or against an intervention be?
- › What factors reduce or increase confidence in effect estimates?
- › How should values and preferences inform clinical recommendations?
- › How does uncertainty in evidence affect decision-making?
- › What is the impact of resource use on recommendation strength?
References & sources
Related methods
Similar by meaning
Beta record. Based on the original catalogue summary; primary-source enrichment pending.