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Health systems

DECIDE work with health systems questions
From our work on health systems questions it became clear that recommendations and decisions depend on information and judgements that are beyond the scope of systematic reviews. Issues in need of consideration include the applicability of the evidence, costs, impacts on equity, acceptability and feasibility. Even when specific answers are not available, when the evidence is too uncertain to provide clear answers, or decision makers' settings vary greatly from those in the studies, policymakers still must make decisions. When there are important uncertainties, as is often the case, they may still decide to implement a change. Being clear about what those uncertainties are can help ensure appropriate monitoring and evaluation when changes are implemented, so that future decisions, such as whether to continue, modify or discontinue changes that were made, will be better informed.

DECIDE addressed the challenges that policymakers face when addressing health systems questions by building on previous work, and developing and evaluating three strategies to communicate evidence-based health system and population (public) health recommendations effectively and efficiently:

 interactive Summary of Findings to facilitate understanding and use of the results of systematic reviews in health system and population health recommendations and decisions

 interactive Evidence to Decision frameworks to facilitate going from evidence to health system and population health recommendations and decisions

 explanations of terms relevant to health system and population health recommendations and decisions

The majority of this work had relevance to other parts of DECIDE and was therefore done in collaboration with teams working with health professionals, the public, policymakers and those looking at medical testing.

Want more information?  A longer summary of our work on on health systems questions can be read as a pdf.



1. Policymakers' and other stakeholders' perceptions of key considerations for health system decisions and the presentation of evidence to inform those considerations: an international survey (

2. GRADE Evidence to Decision (EtD) frameworks: A systematic and transparent approach to making well-informed healthcare choices: 1. Introduction. BMJ 2016 (accepted).

3. GRADE Evidence to Decision (EtD) frameworks: 2. Clinical practice guidelines. BMJ 2016 (accepted).

1. An interactive Summary of Findings table

2. An Evidence to Decision framework to develop medical testing recommendations.

3. An interactive Evidence to Decision tool.

4. The GET IT plain language glossary.

What is happening now?

We, in the context of the GRADE Working Group activities, are going to continue refining the work produced in the DECIDE project. More precisely we will be further developing the multilayer presentation in order to underpin some of the remaining research questions and after receiving feed-back from its implementation in guideline programs internationally.