ADA Evidence Grading System Category/Grade Definition A
Clear evidence from well-conducted, generalizable, randomized
controlled trials that are adequately powered, including: > Evidence from a well-conducted multicenter trial > Evidence from a meta-analysis that incorporated quality ratings in
> Evidence from a well-conducted trial at one or more institutions > Evidence from a meta-analysis that incorporated quality ratings in the analysis
the analysis Compelling nonexperimental evidence, ie, "all or none" rule developed by Center for Evidence Based Medicine at Oxford Supportive evidence from well-conducted randomized controlled trials that are adequately powered, including:
B C
Supportive evidence from well-conducted cohort studies > Evidence from a well-conducted prospective cohort study or registry > Evidence from a well-conducted meta-analysis of cohort studies > Supportive evidence from a well-conducted case-control study
Supportive evidence from poorly controlled or uncontrolled studies > Evidence from randomized clinical trials with one or more major
> Evidence from observational studies with high potential for bias (such as case series with comparison to historical controls)
E
Resources: ADA:
AACE: AADE: ACE: ACP: CMS: IHI:
ISMP: Expert consensus or clinical experience
or three or more minor methodological flaws that could invalidate the results
> Evidence from case series or case reports Conflicting evidence with the weight of evidence supporting the recommendation
American Diabetes Association — www.diabetes.org
American Association of Clinical Endocrinologists — www.aace.com American Association of Diabetes Educators — www.diabeteseducator.org American College of Endocrinology — www.aace.com/College American College of Physicians — www.acponline.org Centers for Medicare & Medicaid Services — www.cms.hhs.gov Institute for Healthcare Improvement — www.ihi.org/ihi Institute for Safe Medication Practices — www.ismp.org
The Joint Commission: www.jointcommission.org OSHA: SHM:
Occupational Safety and Health Administration — www.osha.gov Society of Hospital Medicine — www.hospitalmedicine.org
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