The Article in Brief

Importance of Evidence Grading for Guideline Implementation: The Example of Asthma

David L. Hahn

Background Most current evidence-based guidelines address only evidence quality, but not clinical judgment in the care of individual patients or the role of patient preferences. This article examines strengths and limitations of current evidence-based guidelines using the National Heart, Lung and Blood Institute's new expert panel report on the management of asthma as an example.

What This Study Found The new asthma guidelines, like most other evidence-based guidelines, are limited by a flawed evidence-grading system. Guidelines could be strengthened by more attention to applicable patient populations, patient-oriented outcomes and shared decision making.

Implications

• According to the author, more attention should be paid to the limitations of guidelines and their underlying evidence base as causes for gaps between recommendations and practice.
• Use of more applicable evidence-grading systems with effective decision aids could improve the overall effectiveness of care delivery.