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IX. A Method for Grading Health Care Recommendations

Gordon H. Guyatt, MD; David L. Sackett, MD; John C. Sinclair, MD; Robert Hayward, MD; Deborah J. Cook, MD; Richard J. Cook, PhD; Evidence-Based Medicine Working Group; Eric Bass, MD, MPH; Hertzel Gerstein, MD, MSc; Brian Haynes, MD, MSc; Anne Holbrook, MD, PharmD, MSc; Roman Jaeschke, MD, MSc; Andreas Laupacls, MD, MSc; Virginia Moyer, MD, MPH; Mark Wilson, MD, MPH

JAMA. 1995;274(22):1800-1804.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

THE ULTIMATE PURPOSE of applied health research is to improve health care. Summarizing the literature to adduce recommendations for clinical practice is an important part of the process. Recently, the health sciences community has reduced the bias and imprecision of traditional literature summaries and their associated recommendations through the development of rigorous criteria for both literature overviews^1-3 and practice guidelines.^4,5 Even when recommendations come from such rigorous approaches, however, it is important to differentiate between those based on weak vs strong evidence. Recommendations based on inadequate evidence often require reversal when sufficient data become available,⁶ while timely implementation of recommendations based on strong evidence can save lives.⁶ In this article, we suggest an approach to classifying strength of recommendations. We direct our discussion primarily at clinicians who make treatment recommendations that they hope their colleagues will follow. However, we believe that any clinician who attends to . . . [Full Text PDF of this Article]

Author Affiliations
From the Departments of Medicine (Drs Guyatt, Hayward, and D. J. Cook) and Clinical Epidemiology and Biostatistics(DrsGuyatt, Hayward, D. J. Cook, and Sinclair), and the Department of Pediatrics (Dr Sinclair), McMaster University, McMaster University Faculty of Health Sciences, Hamilton, Ontario; the Centre for Evidence-Based Medicine, Nuffield Department of Medicine, University of Oxford (England) (Dr Sackett); and the Department of Statistics and Actuarial Sciences, Faculty of Mathematics, University of Waterloo (Ontario) (Dr R. J. Cook).

Footnotes
A complete list of members (with affiliations) appears in the first article of this series (JAMA. 1993;270:2093-2095). The following members contributed to this article: Eric Bass, MD, MPH; Hertzel Gerstein, MD, MSc; Brian Haynes, MD, MSc; Anne Holbrook, MD, PharmD, MSc; Roman Jaeschke, MD, MSc; Andreas Laupacis, MD, MSc; Virginia Moyer, MD, MPH; and Mark Wilson, MD, MPH.

Reprint requests to Room 2C12, McMaster University Health Sciences Centre, 1200 Main St W, Hamilton, Ontario, Canada L8N 3Z5 (Dr Guyatt).

Users' Guides to the Medical Literature section editor: Drummond Rennie, MD, Deputy Editor (West), JAMA.

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