Elsevier

Preventive Medicine

Volume 51, Issue 5, November 2010, Pages 421-424
Preventive Medicine

Commentary
AGREE II: Advancing guideline development, reporting, and evaluation in health care

https://doi.org/10.1016/j.ypmed.2010.08.005Get rights and content

Key points

► AGREE II (Appraisal of Guidelines, for Research, and Evaluation), which comprises 23 items and a user's manual, offers refinements of a new way to develop, report, and evaluate practice guidelines. ► Key changes from the original version include a new seven-point response scale, with modifications to half of the items, and a new user's manual. ► AGREE II is available online at the AGREE Research Trust website (www.agreetrust.org).

Section snippets

Redesign of AGREE

In response to these issues, the AGREE Next Steps Consortium was established and undertook two studies (Brouwers et al., 2010a, Brouwers et al., 2010b). As part of the first study, the consortium introduced a new seven-point response scale and evaluated its performance and measurement properties, analyzed the usefulness of the AGREE items for decisions made by different stakeholders, and systematically elicited stakeholders' recommendations for changes to the AGREE items and domains (Brouwers

Changes to AGREE II items

The 23 items in AGREE II are grouped into the same six domains as in the original AGREE instrument. These domains are scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. The key changes from the original document involved refinements to the purpose, response scale, and items of the instrument.

The purpose of the AGREE II is more explicitly stated. The new version of the instrument is designed to assess the quality

Changes to the AGREE II user's manual

The user's manual (Appendix 1) was rewritten and extended with the following information linked to each item:

  • Explicit descriptors for the different levels on the new seven-point scale

  • A description that defines each concept underlying the item and inclusion of specific examples

  • Direction on common places to look for desired information within the guideline document or accompanying documentation

  • A list of common terms or labels to represent the concept

  • Guidance on how to rate the item, including

Knowledge gaps

As with the first version of the AGREE, the items and domains in AGREE II focus on methodologic issues relevant to guideline development and reporting. However, they do not evaluate the clinical appropriateness or validity of the recommendations themselves. While rigorous development and explicit reporting are necessary, they do not guarantee optimal and acceptable recommendations or better health outcomes for patients and populations (Nuckols et al., 2008, Watine et al., 2006). The new item

Using AGREE II

Depending on the structure and length of the guideline document, quality-related assessment of a guideline using AGREE II will take 1.5 hours, on average, per appraiser. Although basic knowledge of the principles of evidence-based decision-making and health care methodology can facilitate its use, the new user's manual should allow novices to use the instrument with confidence. Furthermore, although content-specific expertise on the topic of a guideline is not necessary, it may improve the ease

Funding

This work was supported by the Canadian Institutes of Health Research (CIHR). Michelle Kho is supported by a CIHR Fellowship Award (Clinical Research Initiative).

Competing interests

Melissa Brouwers, Francoise Cluzeau, and Jako Burgers are trustees of the AGREE Research Trust. No competing interests are declared by the other authors.

Contributors

Melissa Brouwers conceived and designed the study, led the collection, analysis and interpretation of the data, and drafted the manuscript. All of the authors made substantial contributions to the study concept and the interpretation of the data, critically revised the article for important intellectual content, and approved the final version of the manuscript to be published.

Acknowledgments

The AGREE Next Steps Consortium thanks the US National Guidelines Clearinghouse for helping to facilitate the identification of eligible practice guidelines for the research program. The consortium also thanks Ms. Ellen Rawski for her support on the project as research assistant from September 2007 to May 2008.

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Cited by (0)

This article has been peer-reviewed.

1

See related research articles by Brouwers and colleagues, available at www.cmaj.ca.

2

Members of the AGREE Next Steps Consortium:Dr. Melissa C. Brouwers, McMaster University and Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ontario; Dr. George P. Browman, British Columbia Cancer Agency, Vancouver Island, British Columbia; Dr. Jako S. Burgers, Dutch Institute for Healthcare Improvement CBO, and Radboud University Nijmegen Medical Centre, IQ Healthcare, Netherlands; Dr. Francoise Cluzeau, Chair of AGREE Research Trust, St. George's University of London, London, UK; Dr. Dave Davis, Association of American Medical Colleges, Washington, USA; Prof. Gene Feder, University of Bristol, Bristol, UK; Dr. Béatrice Fervers, Unité Cancer et Environement, Université de Lyon – Centre Léon Bérard, Université Lyon 1, EA 4129, Lyon, France; Dr. Ian D. Graham, Canadian Institutes of Health Research, Ottawa, Ontario; Dr. Jeremy Grimshaw, Ottawa Hospital Research Institute, Ottawa, Ontario; Dr. Steven E. Hanna, McMaster University, Hamilton, Ontario; Ms. Michelle E. Kho, McMaster University, Hamilton, Ontario; Prof. Peter Littlejohns, National Institute for Health and Clinical Excellence, London, UK; Ms. Julie Makarski, McMaster University, Hamilton, Ontario; Dr. Louise Zitzelsberger, Canadian Partnership Against Cancer, Ottawa, Ontario

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