Quality improvement

Question 1

What is evidence-based medicine?

Answer 1

The integration of:

• best research evidence,
• clinical expertise
• and patient values.

Question 2

How can the quality of clinical evidence be assessed?

Answer 2

1. Hierarchy of study types - Meta-analysis, RCT, non-randomised interventions, observational studies.
2. SIGN grading of recommendations
3. GRADE methodology

Question 3

What is the GRADE methodology?

Answer 3

Grades of Recommendation, Assessment, Development and Evaluation

Recommends:

i) The quality of the evidence is the extent to which the estimate of effect is correct.
ii) The strength of a recommendation is the extent of confidence with which adherence to a recommendation will do more harm than good.

Question 4

What determines the strength of a recommendation in GRADE methodology?

Answer 4

1. Quality of evidence: High, medium, low
2. Trade-offs: Likelihood of benefit over harm
3. Applicability: Right patient group and circumstances
4. Baseline risk confidence

Overall strength of recommendation outcome:

• do it
• don’t do it
• probably do it
• probably don’t do it
• unable to make a recommendation