Comparing the USPSTF and GRADE Approaches to Recommendations
Authors: Diana B. Petitti
Journal: Annals of Internal Medicine (2009)

Letters1 September 2009Comparing the USPSTF and GRADE Approaches to RecommendationsDiana B. Petitti, MD, MPH, Steven M. Teutsch, MD, Mary B. Barton, MD, MPP, George F. Sawaya, MD, Judith K. Ockene, PhD, Med, and Thomas DeWitt, MDDiana B. Petitti, MD, MPHFrom Arizona State University, Phoenix, AZ 85041; Los Angeles County Department of Public Health, Los Angeles, CA 90012; Agency for Healthcare Research and Quality, Rockville, MD 20850; University of California, San Francisco, San Francisco, CA 94143; University of Massachusetts Medical School, Worcester, MA 01655; and University of Cincinnati College of Medicine, Cincinnati, OH 45229.Search for more papers by this author, Steven M. Teutsch, MDFrom Arizona State University, Phoenix, AZ 85041; Los Angeles County Department of Public Health, Los Angeles, CA 90012; Agency for Healthcare Research and Quality, Rockville, MD 20850; University of California, San Francisco, San Francisco, CA 94143; University of Massachusetts Medical School, Worcester, MA 01655; and University of Cincinnati College of Medicine, Cincinnati, OH 45229.Search for more papers by this author, Mary B. Barton, MD, MPPFrom Arizona State University, Phoenix, AZ 85041; Los Angeles County Department of Public Health, Los Angeles, CA 90012; Agency for Healthcare Research and Quality, Rockville, MD 20850; University of California, San Francisco, San Francisco, CA 94143; University of Massachusetts Medical School, Worcester, MA 01655; and University of Cincinnati College of Medicine, Cincinnati, OH 45229.Search for more papers by this author, George F. Sawaya, MDFrom Arizona State University, Phoenix, AZ 85041; Los Angeles County Department of Public Health, Los Angeles, CA 90012; Agency for Healthcare Research and Quality, Rockville, MD 20850; University of California, San Francisco, San Francisco, CA 94143; University of Massachusetts Medical School, Worcester, MA 01655; and University of Cincinnati College of Medicine, Cincinnati, OH 45229.Search for more papers by this author, Judith K. Ockene, PhD, MedFrom Arizona State University, Phoenix, AZ 85041; Los Angeles County Department of Public Health, Los Angeles, CA 90012; Agency for Healthcare Research and Quality, Rockville, MD 20850; University of California, San Francisco, San Francisco, CA 94143; University of Massachusetts Medical School, Worcester, MA 01655; and University of Cincinnati College of Medicine, Cincinnati, OH 45229.Search for more papers by this author, and Thomas DeWitt, MDFrom Arizona State University, Phoenix, AZ 85041; Los Angeles County Department of Public Health, Los Angeles, CA 90012; Agency for Healthcare Research and Quality, Rockville, MD 20850; University of California, San Francisco, San Francisco, CA 94143; University of Massachusetts Medical School, Worcester, MA 01655; and University of Cincinnati College of Medicine, Cincinnati, OH 45229.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-5-200909010-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The USPSTF welcomes this opportunity to further explicate the similarities and differences between the GRADE and USPSTF approaches to making recommendations.Guyatt and colleagues explain that guideline panels that use the GRADE approach may decide not to offer a recommendation and to provide clarifying statements. We agree that GRADE thus accommodates the situation in which the USPSTF uses an I statement. However, the USPSTF “rules of evidence” dictate that an I statement must always be issued if a letter grade of A, B, C, or D cannot be assigned (1, 2). This occurs when the USPSTF judges that ...References1. Barton MB, Miller T, Wolff T, Petitti D, LeFevre M, Sawaya G, et al; U.S. Preventive Services Task Force. How to read the new recommendation statement: methods update from the U.S. Preventive Services Task Force. Ann Intern Med. 2007;147:123-7. [PMID: 17576997] LinkGoogle Scholar2. U.S. Preventive Services Task Force Procedure Manual. AHRQ Publication No. 08-05118-EF. Rockville, Maryland: Agency for Healthcare Research and Quality, July 2008. Accessed at www.ahrq.gov/clinic/uspstf08/methods/procmanual.htm on 7 July 2009. Google Scholar3. Sawaya GF, Guirguis-Blake J, LeFevre M, Harris R, Petitti D; U.S. Preventive Services Task Force. Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net benefit. Ann Intern Med. 2007;147:871-5. [PMID: 18087058] LinkGoogle Scholar4. Petitti DB, Teutsch SM, Barton MB, Sawaya GF, Ockene JK, DeWitt T; U.S. Preventive Services Task Force. Update on the methods of the U.S. Preventive Services Task Force: insufficient evidence. Ann Intern Med. 2009;150:199-205. [PMID: 19189910] LinkGoogle Scholar5. Guyatt GH, Oxman AD, Kunz R, Jaeschke R, Helfand M, Liberati A, et al; GRADE Working Group. Incorporating considerations of resources use into grading recommendations. BMJ. 2008;336:1170-3. [PMID: 18497416] CrossrefMedlineGoogle Scholar6. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, et al; GRADE Working Group. Going from evidence to recommendations. BMJ. 2008;336:1049-51. [PMID: 18467413] CrossrefMedlineGoogle Scholar7. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924-6. [PMID: 18436948] CrossrefMedlineGoogle Scholar8. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ. GRADE Working Group. What is “quality of evidence” and why is it important to clinicians? BMJ. 2008;336:995-8. [PMID: 18456631] CrossrefMedlineGoogle Scholar9. Atkins D, Briss PA, Eccles M, Flottorp S, Guyatt GH, Harbour RT, et al; GRADE Working Group. Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system. BMC Health Serv Res. 2005;5:25. [PMID: 15788089] CrossrefMedlineGoogle Scholar10. Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S, et al; GRADE Working Group. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res. 2004;4:38. [PMID: 15615589] CrossrefMedlineGoogle Scholar11. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al; GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490. [PMID: 15205295] CrossrefMedlineGoogle Scholar12. Schünemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, et al; GRADE Working Group. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008;336:1106-10. [PMID: 18483053] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Diana B. Petitti, MD, MPH; Steven M. Teutsch, MD; Mary B. Barton, MD, MPP; George F. Sawaya, MD; Judith K. Ockene, PhD, Med; Thomas DeWitt, MDAffiliations: From Arizona State University, Phoenix, AZ 85041; Los Angeles County Department of Public Health, Los Angeles, CA 90012; Agency for Healthcare Research and Quality, Rockville, MD 20850; University of California, San Francisco, San Francisco, CA 94143; University of Massachusetts Medical School, Worcester, MA 01655; and University of Cincinnati College of Medicine, Cincinnati, OH 45229.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHow to Read the New Recommendation Statement: Methods Update from the U.S. Preventive Services Task Force Mary B. Barton , Therese Miller , Tracy Wolff , Diana Petitti , Michael LeFevre , George Sawaya , Barbara Yawn , Janelle Guirguis-Blake , Ned Calonge , Russell Harris , and Update on the Methods of the U.S. Preventive Services Task Force: Estimating Certainty and Magnitude of Net Benefit George F. Sawaya , Janelle Guirguis-Blake , Michael LeFevre , Russell Harris , Diana Petitti , and Update on the Methods of the U.S. Preventive Services Task Force: Insufficient Evidence Diana B. Petitti , Steven M. Teutsch , Mary B. Barton , George F. Sawaya , Judith K. Ockene , Thomas DeWitt , and Comparing the USPSTF and GRADE Approaches to Recommendations Gordon H. Guyatt , Mark Helfand , and Regina Kunz Metrics Cited byA Framework for Crafting Clinical Practice Guidelines that are Relevant to the Care and Management of People with Multimorbidity 1 September 2009Volume 151, Issue 5Page: 363-364KeywordsConflicts of interestDecision makingGrading of Recommendations Assessment Development and EvaluationHealth information technology ePublished: 1 September 2009 Issue Published: 1 September 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...