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KMID : 1040120170030010065
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Evidence and Values in Healthcare
2017 Volume.3 No. 1 p.65 ~ p.69
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Evidence-based medicine: Past, present and future role in research, education and clinical care
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Guyatt Gordon H.
Choi Mi-Young
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Abstract
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Evidence-based medicine has 3 principles. Firstly, evidence has hierarchy and some evidences are trustworthy but others are not.Secondly, evidence should be synthesized using systematic review methodology. Finally, value and preference should be considered for decision making. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) is new evidence hierarchy. GRADE is judgement tool for credibility of evidence. Five downgrading factors for all study designs are including risk of bias, inconsistency, indirectness, imprecision and publication bias. Also there are 3 upgrading factors for observational studies. Four key factors influence the direction and the strength of a recommendation are quality of evidence, balance between desirable and undesirable outcomes, value and preference and cost issues. For clinicians using evidence in point of care, GRADE suggested evidence to decision (EtD) framework for clinical decision making. Decision aid technologies were also developed for implementing evidence. Evolution of evidence hierarchy and development of clinical decision supporting tools can help clinicians to use evidence easily and effectively in clinical care.
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KEYWORD
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Evidence-based Medicine, Clinical Decision-Making, Systematic Review, Clinical Practice Guideline
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