Current grading system using in clinical practice guideline recommendations developed by adaptation method

Article type
Authors
Choi M1, Kim SY2, Sheen SS3, Ji SM4, Lyu DHL5, You JH5, Park S5
1GRADE Group and National Evidence-Based Healthcare Collaborating Agency, South Korea
2Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , South Korea
3Department of Pulmonary and Critical Care Medicine Ajou University School of Medicine , South Korea
4National Health Insurance Corporation, South Korea
5National Evidence-Based Healthcare Collaborating Agency, South Korea
Abstract
Background: Recently, many clinical practice guidelines (CPGs) have been developed in South Korea, mostly by adaptation methods. However, guideline developers find it difficult to grade their recommendations because the seed (original) CPGs’ grading systems vary.
Objectives: This study aims to understand the current status and demands for a grading system for CPGs' recommendations when they have been developed by the adaptation method.
Methods: We conducted a systematic search for collecting adaptation guidelines via PubMed, NGC (National Guideline Clearinghouse) and G-I-N (Guideline International Network), Google website. We also included domestic databases such as KoreaMed from 2000 to 2014.
Results: A total of 93 adaptation CPGs (43 domestic) were included in this study. All CPGs had been developed by the adaptation method. Only six CPGs used their own grading system, the other CPGs used other grading systems (90%). The most frequently used grading system (12.9%) was GRADE (The Grading of Recommendations, Assessment, Development and Evaluation). Then OCEM (Oxford Centre for Evidence-based Medicine Levels of Evidence), SIGN (the Scottish Intercollegiate Guidelines Network) and USPSTF (the United States Preventive Service Task Force) were followed. About 62 % of CPGs used evidence tables for grading but others mostly did not mentioned their process about grading. Translation of seed CPGs' grading system were also identified.
Conclusions:There is a need to establish guidance in applying grading system to CPGs developed by adaptation methods. Methodologists should collaborate with CPG developers to develop more trustworthy recommendations.