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Goldzweig CL, Towfigh AA, Paige NM, et al. Systematic Review: Secure Messaging Between Providers and Patients, and Patients’ Access to Their Own Medical Record: Evidence on Health Outcomes, Satisfaction, Efficiency and Attitudes [Internet]. Washington (DC): Department of Veterans Affairs (US); 2012 Jul.
Systematic Review: Secure Messaging Between Providers and Patients, and Patients’ Access to Their Own Medical Record: Evidence on Health Outcomes, Satisfaction, Efficiency and Attitudes [Internet].
Show detailsA summary of GRADE’s approach to rating quality of evidence58
| Study design | Initial quality of a body of evidence | Lower if | Higher if | Quality of a body of evidence |
|---|---|---|---|---|
| Randomized trials | High
 | Risk of Bias −1 Serious | Large Effect +1 Large | High (four plus:⊕⊕⊕⊕) |
| Observational studies | Low
| −2 Very serious | +2 Very large | |
| Inconsistency −1 Serious −2 Very serious | Dose response +1 Evidence of a gradient | Moderate (three plus: ⊕⊕⊕○) | ||
| Indirectness −1 Serious −2 Very serious | All plausible residual confounding +1 Would reduce a demonstrated effect | Low (two plus: ⊕⊕○○) | ||
| Imprecision −1 Serious −2 Very serious | +1 Would suggest a spurious effect if no effect was observed | Very low (one plus: ⊕○○○) | ||
| Publication Bias −1 Likely −2 Very likely |
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