• Maria Kallenbach, Susann Conrad, Frauke Hoffmann, Katja Matthias, Gerald Gartlehner, Gero Langer, and Jörg Meerpohl.
• Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland. Electronic address: maria.kallenbach@g-ba.de.
• Z Evid Fortbild Qual Gesundhwes. 2019 Aug 1; 144-145: 90-99.

BackgroundGuideline developers can: (1) adopt existing recommendations from others; (2) adapt existing recommendations to their own context; or (3) create recommendations de novo. Monetary and nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes.ObjectivesTo describe a potentially efficient model for guideline production based on adoption, adaptation, and/or de novo development of recommendations utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks.Study Design And SettingWe applied the model in a new national guideline program producing 22 practice guidelines. We searched for relevant evidence that informs the direction and strength of a recommendation. We then produced GRADE EtDs for guideline panels to develop recommendations.ResultsIn two waves, a total of 80 EtD frameworks was produced approximately 4 months and 146 EtDs in about 6 months. Use of the EtD frameworks allowed panel members to understand judgments of other guideline groups about the criteria that bear on guideline recommendations and then make their own judgments about those criteria in a systematic approach.ConclusionThe "GRADE-ADOLOPMENT" approach to guideline production combines adoption, adaptation, and, as needed, de novo development of recommendations. If guideline developers apply EtD criteria more widely and make their work publically available, this approach should prove even more useful.Copyright © 2019. Published by Elsevier GmbH.

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