GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale

Vivian A Welch; Elie A Akl; Gordon Guyatt; Kevin Pottie; Javier Eslava-Schmalbach; Mohammed T Ansari; Hans de Beer; Matthias Briel; Tony Dans; Inday Dans; Monica Hultcrantz; Janet Jull; Srinivasa Vittal Katikireddi; Joerg Meerpohl; Rachael Morton; Annhild Mosdol; Jennifer Petkovic; Holger J Schünemann; Ravi N Sharaf; Jasvinder A Singh; Roger Stanev; Thomy Tonia; Mario Tristan; Sigurd Vitols; Joseph Watine; Peter Tugwell

doi:10.1016/j.jclinepi.2017.01.014

GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale

J Clin Epidemiol. 2017 Oct:90:59-67. doi: 10.1016/j.jclinepi.2017.01.014. Epub 2017 Apr 12.

Authors

Vivian A Welch¹, Elie A Akl², Gordon Guyatt³, Kevin Pottie⁴, Javier Eslava-Schmalbach⁵, Mohammed T Ansari⁶, Hans de Beer⁷, Matthias Briel⁸, Tony Dans⁹, Inday Dans¹⁰, Monica Hultcrantz¹¹, Janet Jull¹², Srinivasa Vittal Katikireddi¹³, Joerg Meerpohl¹⁴, Rachael Morton¹⁵, Annhild Mosdol¹⁶, Jennifer Petkovic¹², Holger J Schünemann³, Ravi N Sharaf¹⁷, Jasvinder A Singh¹⁸, Roger Stanev¹⁹, Thomy Tonia²⁰, Mario Tristan²¹, Sigurd Vitols²², Joseph Watine²³, Peter Tugwell²⁴

Affiliations

¹ Bruyère Research Institute, Bruyère Continuing Care, University of Ottawa, 304b-85 Primrose Avenue, Ottawa, Ontario, Canada K1R 6M1; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Faculty of Medicine, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G-5Z3. Electronic address: [email protected].
² Department of Internal Medicine, American University of Beirut, P.O. Box 11-0236, Riad-El-Solh Beirut 1107 2020, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (formerly "Clinical Epidemiology and Biostatistics") and Department of Medicine, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Room HSC-2C12, Hamilton, Ontario, Canada L8S 4K1.
³ Department of Health Research Methods, Evidence, and Impact (formerly "Clinical Epidemiology and Biostatistics") and Department of Medicine, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Room HSC-2C12, Hamilton, Ontario, Canada L8S 4K1.
⁴ Departments of Family Medicine and Epidemiology and Community Medicine, and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Faculty of Medicine, Room 3105, 451 Smyth Road, Roger-Guindon Building, Ottawa, Ontario, Canada K1H 8M5.
⁵ Hospital Universitario Nacional de Colombia, Equity-in-Health Group, Faculty of Medicine, Universidad Nacional de Colombia, University Campus, Cra 30 45-03, Bogota, Colombia; Technology Development Centre, Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E.), Carrera 15A 120-74, Bogota, Colombia.
⁶ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Faculty of Medicine, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G-5Z3.
⁷ Guide2Guidance, Lemelerberg 7, 3524 LC, Utrecht, The Netherlands; International Institute of Social History, Cruquiusweg 31, 1019 AT Amsterdam, The Netherlands.
⁸ Department of Health Research Methods, Evidence, and Impact (formerly "Clinical Epidemiology and Biostatistics") and Department of Medicine, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Room HSC-2C12, Hamilton, Ontario, Canada L8S 4K1; Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland.
⁹ College of Medicine, University of the Philippines, Manila, Philippines.
¹⁰ Department of Pediatrics, University of the Philippines-Manila, Taft Avenue, Manila 1000, Philippines.
¹¹ Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), S:t Eriksgatan 117, SE-102 33, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodav. 18 A, SE-171 77, Stockholm, Sweden.
¹² Bruyère Research Institute, Bruyère Continuing Care, University of Ottawa, 304b-85 Primrose Avenue, Ottawa, Ontario, Canada K1R 6M1.
¹³ MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow G2 3QB, United Kingdom.
¹⁴ Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité - U1153, Inserm/Université Paris Descartes, Cochrane France, Hôpital Hôtel-Dieu, Paris, France.
¹⁵ NHMRC Clinical Trials Centre, The University of Sydney, Medical Foundation Building Level 6, 92-94 Parramatta Road, Camperdown, NSW, 2050, Australia.
¹⁶ Knowledge Centre for the Health Services, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, N-0403 Oslo, Norway.
¹⁷ Division of Gastroenterology, Department of Medicine, Northwell Health/Hofstra University School of Medicine, 300 Community Drive, Manhasset, New York, 11030 USA.
¹⁸ University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA.
¹⁹ Institute of Technology, University of Washington, 1900 Commerce St., Tacoma, WA, USA, 98402.
²⁰ University of Bern, Institute of Social and Preventive Medicine, Niesenweg 6, 3012, Bern, Switzerland.
²¹ IHCAI Foundation & Cochrane Central America & Spanish Speaking Caribbean Av 7 calles 35 y 37 No 35 30 Codigo Postal 10106 San Jose Costa Rica.
²² Department of Medicine, Clinical Pharmacology Unit, Karolinska Institute, L7:03, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
²³ Laboratory Medicine, Hôpital La Chartreuse, Villefranche-de-Rouergue, France.
²⁴ Department of Medicine, University of Ottawa, Faculty of Medicine, Ottawa, Canada K1H 8M5.

Abstract

Objectives: This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines.

Study design and setting: We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve.

Results: We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation.

Conclusion: Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development.

Keywords: GRADE; Guidelines; Health equity; Socially disadvantaged; Specific populations; Underserved.

MeSH terms

Evidence-Based Practice
Health Equity*
Humans
Practice Guidelines as Topic / standards*
Research Design
Vulnerable Populations*

Abstract

MeSH terms

Grants and funding