Abstract
Clinical practice guidelines (CPGs) may lack rigor and suitability to the setting in which they are to be applied. Methods to yield clinical practice guideline recommendations that are credible and implementable remain to be determined. To describe the development of AGREE-REX (Appraisal of Guidelines Research and Evaluation-Recommendations Excellence), a tool designed to evaluate the quality of clinical practice guideline recommendations. A cross-sectional study of 322 international stakeholders representing CPG developers, users, and researchers was conducted between December 2015 and March 2019. Advertisements to participate were distributed through professional organizations as well as through the AGREE Enterprise social media accounts and their registered users. Between 2015 and 2017, participants appraised 1 of 161 CPGs using the Draft AGREE-REX tool and completed the AGREE-REX Usability Survey. Usability and measurement properties of the tool were assessed with 7-point scales (1 indicating strong disagreement and 7 indicating strong agreement). Internal consistency of items was assessed with the Cronbach α, and the Spearman-Brown reliability adjustment was used to calculate reliability for 2 to 5 raters. A total of 322 participants (202 female participants [62.7%]; 83 aged 40-49 years [25.8%]) rated the survey items (on a 7-point scale). All 11 items were rated as easy to understand (with a mean [SD] ranging from 5.2 [1.38] for the alignment of values item to 6.3 [0.87] for the evidence item) and easy to apply (with a mean [SD] ranging from 4.8 [1.49] for the alignment of values item to 6.1 [1.07] for the evidence item). Participants provided favorable feedback on the tool's instructions, which were considered clear (mean [SD], 5.8 [1.06]), helpful (mean [SD], 5.9 [1.00]), and complete (mean [SD], 5.8 [1.11]). Participants considered the tool easy to use (mean [SD], 5.4 [1.32]) and thought that it added value to the guideline enterprise (mean [SD], 5.9 [1.13]). Internal consistency of the items was high (Cronbach α = 0.94). Positive correlations were found between the overall AGREE-REX score and the implementability score (r = 0.81) and the clinical credibility score (r = 0.76). This cross-sectional study found that the AGREE-REX tool can be useful in evaluating CPG recommendations, differentiating among them, and identifying those that are clinically credible and implementable for practicing health professionals and decision makers who use recommendations to inform clinical policy.
Highlights
Clinical practice guidelines (CPGs) are systematically developed statements informed by a systematic review of evidence and an assessment of the benefits and harms of care options designed to optimize patient care.[1,2,3] The potential benefits of CPGs, are only as good as their quality
This cross-sectional study found that the AGREE-REX tool can be useful in evaluating CPG recommendations, differentiating among them, and identifying those that are clinically credible and implementable for practicing health professionals and decision makers who use recommendations to inform clinical policy
The review resulted in the Guideline Implementability for Decision Excellence Model (GUIDE-M) that was vetted by the international CPG community.[30]
Summary
Clinical practice guidelines (CPGs) are systematically developed statements informed by a systematic review of evidence and an assessment of the benefits and harms of care options designed to optimize patient care.[1,2,3] The potential benefits of CPGs, are only as good as their quality. The Appraisal of Guidelines, Research and Evaluation revision (AGREE II) tool has become an accepted international resource to evaluate the quality of CPGs and to provide a methodologic framework to inform CPG development, reporting, and evaluation.[5,6,7,20,21,22] The AGREE II tool targets the entire CPG development process and all components of the CPG report: the articulation of scope and practice, who is involved, methods used, applicability, editorial independence, and clarity Appropriate methods and rigorous development strategies are important factors in the successful implementation of CPG recommendations.[4,5,6,7,8,9,10] Not all CPGs are alike; their quality is variable and often falls short of reported goals.[11,12,13,14,15,16,17,18,19]
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