A multi-layered approach to base decisions in systematic reviews and the GRADE approach: The Chilean National Guideline Program Case

Presentation video:




Oral session: Knowledge translation and communicating evidence (1)


Tuesday 22 October 2019 - 11:00 to 12:30


All authors in correct order:

Rodriguez F1, Herrera P2, Burdiles P2, Kraemer P2, Sepulveda D3, Pimentel L3, Quiñelen E3, Contreras M2, Pesso BP4, Olave P4, Salas F4, Rojas DR4, Zecchetto S4, Caba F4, Camus J4, Ganchozo N4, Bobadilla MB4, Vasquez V4, Madrid E5, Perez-Bracchiglione J5, Meza N5, Garnham R5, Sanchez L5, Neumann I3
1 Universidad San Sebastian, Chile
2 Ministerio de Salud de Chile, Chile
3 Ministerio de Salud de Chile, Chile
4 Universidad San Sebastian, Chile
5 Universidad de Valparaíso, Chile
Presenting author and contact person

Presenting author:

Francisca Rodríguez

Contact person:

Abstract text
Background: before 2016, clinical guidelines developed by the Ministry of Health were not based on systematic reviews. Also, panels were not multidisciplinary and the recommendations were based mainly on expert opinion. As result, studies assessing the quality of recommendations showed that most were not trustworthy.

In 2016, we introduced a multilayered intervention at five levels. First, we changed the composition and operation of guideline panels. Panels now included methods experts, patients and payers’ representatives. Additionally, methodologists had the responsibility of conducting the process and drafting the final recommendations. Second, a policy for managing conflict of interest was enforced. Third, all the recommendations were based on systematic reviews of the evidence about the effect of the intervention, patients’ values and preferences, and resource utilization data. Fourth, the process of developing recommendations was conducted and explicitly reported following the GRADE approach and Evidence to Decision Tables. Finally, recommendations were published in an online platform friendly to mobile devices.

Objectives: to evaluate the trustworthiness of recommendations developed after a multi-layered intervention based on systematic reviews and the GRADE approach.

Methods: teams of two investigators blindly and independently assessed all the recommendations published by the Ministry of Health on 2016 and afterwards used the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation). Disagreements were recorded and resolved by consensus. We compared the results of this evaluation with a previous study conducted by us, in which we evaluated the quality of recommendations published before 2016.

Results: this study is ongoing and the results will be presented at the Colloquium.

Conclusions: preliminary data suggest that the multilayered intervention has significantly increased the trustworthiness of recommendations.

Patient or healthcare consumer involvement: although patients and healthcare consumers were not involved in this study, they had an active role in the interventions reported. Specifically, patients and health consumers were included in guideline panels as voting members.