Using the GRADE Process to Improve Patient Care: A Practical Experience

While grading schemes have been around and readily used by health care professionals for more than 30 years, evaluations of health care evidence and recommendations have always been—and remain—complex. After all, when considering the wide range of evidence sources, from small laboratories to well-designed large-scale clinical studies, and varying ways in which recommendations are developed, it makes sense that health care providers are still working to improve best practices to determine what works best for improving patient care.

Dr. Joel V. Brill, medical director at FAIR Health, Inc., shared his experience working with the American Gastroenterological Association (AGA) on its process for developing guidelines during a video interview with the National Pharmaceutical Council (NPC). Dr. Brill pointed out that roughly a decade ago, the AGA published a set of criteria—currently available to the public—that outline how the Association identifies measures and topics for guideline development. 

Like many others in the health care industry, the AGA uses the well-recognized Grading of Recommendations Assessment, Development and Evaluation (GRADE) process to evaluate and develop evidence-based guidelines. GRADE employs a multi-stakeholder, iterative and intensive process during which a team identifies a topic, then the quality of evidence undergoes a technical review, from which the guidelines are written and developed by clinical experts and a GRADE methodologist. Finally, the clinical practice guidelines are reviewed and, after the AGA governing board approves the guidelines, they are published.

During the discussion with NPC, Dr. Brill explained that AGA works to identify and focus on topics that are controversial, where there is a lack of clarity, or where the AGA is trying to align and create opportunities for collaboration and improved outcomes with payers, external quality entities, fellow health care providers and—importantly—patients. When it comes to developing guidelines, says Dr. Brill, the bottom line is really about “identifying best practices and opportunities for improving patient care.“

Want to learn about quality measures? The University of Maryland School of Pharmacy and NPC have partnered to develop an online continuing education series, “Healthcare Quality: Measurement and Implications,” which provides a comprehensive overview of the health care quality landscape, including national priorities, and measure development, endorsement and implementation. The series includes two interactive modules, “Healthcare Quality in the United States,” and “Quality Measurement for the Pharmaceutical Industry,” for health care decision-makers (i.e., pharmacists, researchers, stakeholders and industry leaders).