The structure of the quality of clinical practice guidelines with the items and overall assessment in AGREE II: a regression analysis

Yosuke Hatakeyama,Rebeka Amin,Shigeru Fujita,Tomonori Hasegawa,Takefumi Kitazawa,Kanako Seto,Kunichika Matsumoto

doi:10.1186/s12913-019-4532-0

Abstract

BackgroundThe Appraisal of Guidelines for Research & Evaluation (AGREE) II has been widely used to evaluate the quality of clinical practice guidelines (CPGs). While the relationship between the overall assessment of CPGs and scores of six domains were reported in previous studies, the relationship between items constituting these domains and the overall assessment has not been analyzed. This study aims to investigate the relationship between the score of each item and the overall assessment and identify items that could influence the overall assessment.MethodsAll Japanese CPGs developed using the evidence-based medicine method and published from 2011 to 2015 were used. They were independently evaluated by three appraisers using AGREE II. The evaluation results were analyzed using regression analysis to evaluate the influence of 6 domains and 23 items on the overall assessment.ResultsA total of 206 CPGs were obtained. All domains and all items except one were significantly correlated to the overall assessment. Regression analysis revealed that Domain 3 (Rigour of Development), Domain 4 (Clarity of Presentation), Domain 5 (Applicability), and Domain 6 (Editorial Independence) had influence on the overall assessment. Additionally, four items of AGREE II, clear selection of evidence (Item 8), specific/unambiguous recommendations (Item 15), advice/tools for implementing recommendations (Item 19), and conflicts of interest (Item 22), significantly influenced the overall assessment and explained 72.1% of the variance.ConclusionsThese four items may highlight the areas for improvement in developing CPGs.

Highlights

Clinical practice guidelines (CPGs) are statements that include recommendations based on “a systematic review of evidence and an assessment of the benefits and harms of alternative care options” for assisting “practitioner and patient decisions” [1, 2]
Regarding the relationship between quality and application of Clinical Practice Guideline (CPG), O’Sullivan et al clarified that high “scores in some domains of Appraisal of Guidelines for Research & Evaluation (AGREE) II tool were significantly associated with reductions in nonadherent testing” [32]
Based on the results of evaluation using AGREE II, this study aims to investigate the influence of AGREE II items on the overall assessment of CPGs

Summary

Introduction

Clinical practice guidelines (CPGs) are statements that include recommendations based on “a systematic review of evidence and an assessment of the benefits and harms of alternative care options” for assisting “practitioner and patient decisions” [1, 2]. Previous studies regarding the quality of CPGs were limited to specific health topics or regions [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39] and systematic reviews using these studies [40,41,42]. The Appraisal of Guidelines for Research & Evaluation (AGREE) II has been widely used to evaluate the quality of clinical practice guidelines (CPGs). While the relationship between the overall assessment of CPGs and scores of six domains were reported in previous studies, the relationship between items constituting these domains and the overall assessment has not been analyzed. This study aims to investigate the relationship between the score of each item and the overall assessment and identify items that could influence the overall assessment

Objectives

Methods

Results