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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.

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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].

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APPENDIX CCRITERIA USED IN QUALITY ASSESSMENT

A summary of GRADE’s approach to rating quality of evidence58

Study designInitial quality of a body of evidenceLower ifHigher ifQuality of a body of evidence
Randomized trialsHigh Image appcfu1.jpgRisk of Bias
 −1 Serious
Large Effect
 +1 Large
High (four plus:⊕⊕⊕⊕)
Observational studiesLow Image appcfu1.jpg −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 observedVery low (one plus: ⊕○○○)
Publication Bias
 −1 Likely
 −2 Very likely

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