On the goodness of recommendations: the changing face of practice parameters.

摘要: AS THE CURRENT DEBATE OVER HEALTH CARE REFORM INTENSIFIES AND MANDATE TO CONTROL EVER-ESCALATING COSTS MOVES the top of political agenda, evidence based medicine is becoming increasingly recognized as a critical instrument to help manage these issues. Evidence may be globally defined judicious use best current in making decisions about care individual patient. While term “evidence medicine” (EBM) first appeared medical literature 1990,1 traces EBM origins date back ancient Greek and Chinese medicine. The Standards Practice Committee was founded early 1990s produced some practice guidelines (Figure 1). Figure 1 Cumulative parameter products Committee In world, “evidence” generally considered consist published opinions results various trials or studies regarding health care. Deciding what “the evidence” necessitates development system that can used judge which conclusions trust more less. last two decades have seen emergence multitude grading systems with varying successes. (SPC) American Academy Sleep Medicine (AASM) has developed 31 parameter/best practices papers on systematic review existing an effort provide diagnostic treatment strategies for typical practitioners. Oxford Levels been primary by SPC grade assign recommendations. A significant advantage this it lends itself many types covering aspects management patients, including diagnosis well therapeutic interventions. However, inherent limitations (as others) include lack framework separately evaluate rigor available strength There implicit implication strong leads This approach ignores other factors are developing recommendations, such values, effect size, risks, costs, alternative options. Such result misinterpretation assigned recommendations practitioners, insurance companies, policy makers. In incorporate strengths preexisting while addressing their inadequacies, guideline developers, methodologists, clinicians collaborated form Grades Recommendation, Assessment, Development, Evaluation (GRADE) Working Group.2 Since then, number international national professional organizations adopted GRADE either its original format modifications development. This document intends explicate advantages offered over our previously assessment elucidate modified being implementation Task Forces commissioned AASM leadership.