Grade Equity Guidelines 1: Considering Health Equity in Grade Guideline Development: Introduction and Rationale

Welch VA, Akl EA, Guyatt G, Pottie K, Eslava-Schmalbach J, Ansari MT, de Beer H, Briel M, Dans T, Dans I, Hultcrantz M, Jull J, Katikireddi SV, Meerpohl J, Morton R, Mosdol A, Petkovic J, Schunemann HJ, Sharaf RN, Singh JA, Stanev R, Tonia T, et al
Source: J Clin Epidemiol
Publication Year: 2017
Population Focus: Vulnerable/disadvantaged
Intervention Type: Best practices
Study Design: Other Study Design
Type of Literature: White
link: https://www.ncbi.nlm.nih.gov/pubmed/28412464
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 listserv.

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.

Insights Results

Overview of article

  • This article provides an overview of a 4-part series on how guideline panels can consider evidence for health equity in guideline development, thus informing individual clinical discussions, using the Grading Recommendations, Assessment, Development, and Evaluations (GRADE) framework

Methods of article

  • The research team searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. Then, there were three meetings with GRADE Working Group members invitation of comments from the GRADE Working Group listserv

Results

  • When considering health inequity, guideline panels should decide which disadvantaged populations are related to the topic. PROGRESS-Plus: Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, is a useful acronym that can help guideline panels consider health equity issues. Plus indicates that other characteristics (e.g., disability, age) may also need to be considered
  • 4 prompts may be considered to assess whether a guideline question is sensitive to health equity: 1) Are there groups or settings that might be disadvantaged in relation to the problem or intervention of interest?; 2) Are there plausible reasons for anticipating differences in the relative effectiveness of the intervention for disadvantaged groups or settings?; 3) Are there different baseline conditions across groups or settings that affect the absolute impact of the intervention or the importance of the problem for disadvantaged groups or settings?; and 4) Are there important considerations that people implementing the intervention should consider to ensure that inequities are reduced, if possible, and that they are not increased?
  • The workgroup used the term “disadvantaged” to describe populations at risk for health inequities because it is explicit in describing people as experiencing an unfair opportunity to attain their health potential
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