The approaches of the GRADE working group and the USPSTF have many elements in common. Both place separate attention on assessing the evidence and making a recommendation on the basis of the evidence. The GRADE approach assigns evidence “quality” at 1 of 4 levels: very low, low, moderate, and high, on the basis of specific criteria. The USPSTF assigns evidence “certainty” at 1 of 3 levels: high, moderate, and low, on the basis of 6 critical appraisal questions. The GRADE criteria are similar to the USPSTF's 6 questions. The recommendation phase for both GRADE (4 - 6) and the USPSTF rely on a judgment of net benefits (benefits minus harms), including whether net benefits are positive, negative, or uncertain. The GRADE process more directly includes costs than the USPSTF approach, although the USPSTF does consider the time and effort of patients and providers. The GRADE working group is developing a system that will apply to many areas, including public health, diagnostic, treatment, and prevention issues, whereas the USPSTF is more narrowly focused on prevention.