Pan American Health Organization · 2022
Systematic methods for using research evidence in clinical, public-health and health-system decisions, adapted for rapid response during emergencies.
- Issuer
- Pan American Health Organization
- Edition
- 2022
- Audience
- Researchers, policymakers, health programme managers, healthcare professionals, stakeholders involved in developing or using evidence products
- Evidence
- Framework document with extensive references to GRADE methodology, WHO guideline development standards, Cochrane methods, and international best practice in knowledge translation
- Reviewed
- 18 Oct 2026 · GMJ
What this guideline says
GMJ summary
This comprehensive guide from PAHO presents a structured approach to evidence-informed decision-making (EIDM) across clinical practice, public health, and health systems. It emphasises that decisions should be informed by the best available research evidence while considering context, equity, feasibility, cost-effectiveness, and acceptability to stakeholders. The guide introduces the ‘evidence funnel’ (primary research → systematic reviews → evidence products like guidelines, HTAs, and evidence briefs for policy) and the ‘policy/action cycle’ that links research to health outcomes.
The EIDM process comprises four evidence-dependent steps: identifying high-priority issues, selecting interventions/options, appraising implementation considerations, and monitoring/evaluating impact. Throughout, the guide stresses the importance of systematic reviews as the core of evidence synthesis, the GRADE approach for assessing certainty of evidence, and the involvement of stakeholders including decisionmakers, clinicians, and affected populations.
A dedicated chapter addresses EIDM during health emergencies, drawing lessons from COVID-19. The pandemic revealed both strengths (unprecedented international collaboration, living reviews and guidelines) and weaknesses (duplication, low-quality studies, misinformation, use of unproven treatments). The guide proposes solutions including rapid review methods, living systematic reviews, evidence networks, coordinated international trials, minimum quality standards, and stronger institutionalisation of EIDM capacity—especially in low- and middle-income countries—before the next emergency strikes.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Evidence-informed decision-making should follow four core steps: identify high-priority issue using surveillance and burden-of-disease data; select interventions based on systematic reviews of benefits, harms and cost-effectiveness; appraise implementation barriers using qualitative evidence and local context; monitor and evaluate using appropriate study designs.
- Systematic reviews are the cornerstone of EIDM, providing synthesis of all relevant studies with quality assessment; GRADE approach rates certainty of evidence as high, moderate, low or very low based on risk of bias, inconsistency, imprecision, indirectness and publication bias.
- Evidence products—clinical/public-health guidelines, health technology assessments (HTAs), and evidence briefs for policy (EBPs)—should use transparent methods, involve stakeholders, manage conflicts of interest, and present findings in user-friendly 1:3:25 format (one page main messages, three-page summary, up to 25 pages full report).
- Health equity must be considered throughout EIDM using PROGRESS-Plus framework (place, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus age and disability) to identify disadvantaged groups and assess differential impacts.
- During health emergencies, rapid reviews (maintaining minimum quality standards), living systematic reviews (continuously updated), living guidelines, and coordinated international trials are essential; unproven interventions should only be used within research protocols or under MEURI framework until RCTs can be conducted.
- Institutionalisation of EIDM requires mandates for evidence use, revision of academic promotion criteria to value knowledge translation, legislation requiring publication of policy evidence bases, and funding mechanisms supporting researcher-decisionmaker collaboration.
- For low- and middle-income countries: focus on adapting high-quality international evidence products to local context, build capacity in systematic review methods and GRADE, ensure free access to research databases (e.g. Hinari), improve cause-of-death reporting, and establish mechanisms to manage conflicts of interest.
- Quality standards must be enforced: systematic reviews should meet AMSTAR 2 criteria, guidelines AGREE II standards, primary studies appropriate reporting checklists (e.g. CONSORT for RCTs), with prospective registration of all protocols to reduce duplication and enable quality checking before publication.
Sources of research evidence to inform implementation considerations
Table extracted from the guideline
| Type of evidence | Sources of research evidence | Comments |
|---|---|---|
| Systematic reviews of implementation strategies | Cochrane Effective Practice and Organisation of Care (EPOC) reviews | High-quality systematic reviews of educational, behavioural, financial, regulatory, and organizational interventions designed to improve health professional practice |
| Systematic reviews of qualitative studies | See systematic review sources (Cochrane, Health Systems Evidence, Epistemonikos) | Inform understanding of barriers, facilitators, values and preferences |
| Primary studies in local context | EVID@Easy tool, PubMed specialized searches, national surveys, routine health information | Studies must be evaluated for quality; EVID@Easy helps locate evidence by decision-making stage |
| Rx for change database | CADTH Rx for change | Summaries of evidence from systematic reviews of intervention strategies to alter prescribing and practice behaviours, with quality assessment |
Source: Pan American Health Organization, A Guide for Evidence-Informed Decision-Making, Including in Health Emergencies. Reproduced in summary form.
From the guideline
Verbatim
“The evidence-informed approach to decision-making is, at its core, about better decisions for better health, avoiding harm, and making more effective use of scarce resources.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia and someone who has worked with WHO on health system strengthening, I see this PAHO guide as essential reading for our region's health leaders. The framework it presents—moving systematically from evidence synthesis through guidelines and HTAs to policy implementation—addresses a persistent gap in our national health decision-making processes. For Georgian colleagues I would stress the practical recommendation to focus first on adapting high-quality international evidence products like WHO guidelines to our local context, rather than attempting to produce every systematic review locally, which allows us to build capacity progressively. The guide's emphasis on managing conflicts of interest is particularly timely given ongoing challenges in pharmaceutical policy and procurement across the Caucasus. However, implementation will require sustained political commitment: establishing the proposed legislation mandating publication of policy evidence bases, revising academic promotion criteria at Tbilisi State Medical University and other institutions to reward knowledge translation work, and securing reliable funding for a national EIDM unit—none of which will happen without ministerial champions and budget allocation in a constrained fiscal environment.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 18 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus region, this guide provides a practical framework to strengthen national capacity for evidence-informed health decision-making. Countries in the region should prioritise: establishing or strengthening national guideline development programmes and HTA mechanisms (Georgia established its HTA unit in recent years); building academic and ministry capacity in systematic review methods and critical appraisal; ensuring access to research databases through WHO Hinari; improving vital registration and cause-of-death reporting quality; and creating knowledge-translation platforms linking researchers and policymakers, potentially through EVIPNet networks. The guide’s emphasis on adaptation of international evidence products to local context is especially relevant where academic resources are limited. National programmes should develop protocols for rapid evidence synthesis during outbreaks (relevant given recurring threats in the region), establish registries to avoid research duplication, introduce legislation requiring publication of evidence underpinning health policies, and revise academic promotion criteria to reward knowledge translation alongside traditional publication metrics.
Questions this guideline answers
Quick answers
What is the difference between evidence-based and evidence-informed decision-making?
Evidence-informed decision-making acknowledges that while research evidence on effectiveness and safety is essential, many other factors influence decisions including context, public opinion, institutional constraints, equity impacts, feasibility, affordability, sustainability and acceptability to stakeholders. These factors can be explicitly incorporated into the decision-making process in a transparent way, often supported by research evidence, whereas evidence-based approaches historically focused primarily on effectiveness.
What are the minimum requirements for EIDM capacity in resource-limited settings?
Minimum requirements include: mechanisms to regulate conflicts of interest; ministry of health capacity for critical appraisal of systematic reviews and evidence products; access to research databases (e.g. WHO Hinari); improved cause-of-death reporting and health indicator surveillance; minimum capacity in epidemiology and cost analysis for policy reports; mid-long-term projects to build research methods capacity; and dedicated funding for EIDM activities in donor requests. Where academic capacity is limited, focus on adapting high-quality international evidence products rather than producing new systematic reviews.
How should unproven interventions be used during health emergencies when evidence is insufficient?
Unproven therapeutics should only be offered within research protocols, specifically randomized controlled trials capable of assessing safety and efficacy. If conducting research is not immediately possible, use may be justified under the WHO Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI) framework until an RCT can be initiated. Outside these contexts, decisions must transparently acknowledge uncertainty, assess risks versus benefits through stakeholder deliberation, include well-designed evaluation, and be updated regularly as new evidence emerges.
What quality standards should systematic reviews meet before being used for decision-making?
Systematic reviews should meet minimum standards based on AMSTAR 2 criteria including: clearly stated objectives and eligibility criteria based on PICO; comprehensive literature search of multiple databases; duplicate study selection and data extraction; assessment of risk of bias in included studies; appropriate synthesis methods; assessment of certainty of evidence (ideally using GRADE); consideration of risk of bias when interpreting results; and transparent reporting following PRISMA guidelines. Commissioning organizations and journals should require quality assessment using tools like AMSTAR 2 prior to publication, not rely on peer review alone.
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- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- 2022
- Status
- Current
- Published
- 2022-01-01
- Languages
- English
- Scope
- Clinical practice, public health and health systems decisions; development of guidelines, HTAs and evidence briefs for policy; EIDM in health emergencies
- Audience
- Researchers, policymakers, health programme managers, healthcare professionals, stakeholders involved in developing or using evidence products
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Framework document with extensive references to GRADE methodology, WHO guideline development standards, Cochrane methods, and international best practice in knowledge translation
- Record history
- Created 18 Oct 2026 · updated 18 Oct 2026 · next check Apr 2027
Pan American Health Organization. A Guide for Evidence-Informed Decision-Making, Including in Health Emergencies. Washington, D.C.: PAHO; 2022. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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