Rating the quality of evidence for clinical practice guidelines

David C. Hadorn, David Baker, James S. Hodges, Nicholas Hicks

Research output: Contribution to journalArticlepeer-review

233 Scopus citations


This article describes the system for rating the quality of medical evidence developed and used during creation of the Agency for Health Care Policy and Research sponsored heart failure guideline. Previous approaches to rating evidence were not designed for use in the setting of clinical practice guidelines. The present system is based on the tenet that flaws in research design are serious to the extent they threaten the validity of the results of studies. A taxonomy of major and minor flaws based on that tenet was developed for randomized controlled trials and for cohort and medical registry studies. The use of the system is described in the context of two difficult clinical issues considered by the Panel: the role of coronary artery revascularization and the use of metoprolol.

Original languageEnglish (US)
Pages (from-to)749-754
Number of pages6
JournalJournal of Clinical Epidemiology
Issue number7
StatePublished - Jul 1996

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