agree ii instrument: assessment of the quality of clinical practice guidelines
TRANSCRIPT
InstructorDr. Yasser Sami Amer
MS Pediatrics, MS Healthcare InformaticsCPGs General Coordinator, KSUHs, AUHs
Member, G-I-N Adaptation & GIRAnet Working Groups
Purpose
To guide on how to use and apply the AGREE II for assessing CPGSItemsDomainsUser’s Manual
Outlines
• Overview of AGREE II including the items and
domains.
• Present the scoring method of the CPG.
• How to use and apply the AGREE II for assessing
CPG.
• Share the overall scoring.
What is the AGREE II Tool ?
• Quality (Methodological rigor & transparency; confident in resulting Recommendations)
4 Using the AGREE II Instrument
Assess
Guide •CPGs Development •CPGs Reporting
History 1st AGREE was published in 2003,then refined in 2009 AGREE II (New scoring “7 point scale” – Items modifications – New user’s manual)
Can be applied to any CPG in any Disease area !
• Healthcare providers
• CPG developers/ adapters
• Policy makers
• Educators
Who can use the AGREE II ?
Considerations before a CPG Assessment
• increase the reliability of the assessment
2 – 4 Appraisers
• in full and obtain all related information and needed documents before undertaking the AGREE II assessment ( to make a well informed assessment)
Read CPG first
Rating Scale• All AGREE II Items are rated on the following 7-point scale
Score Meaning7 (Strongly Agree)
= If the quality of reporting is exceptional and full criteria and considerations in User’s manual are met.
1 (Strongly Disagree)
= No information relevant to AGREE II item OR the concept is very poorly reported
2 – 6 = when the reporting of the item does not meet the full criteria or considerations, depending on the completeness & quality of reporting .
The AGREE II Includes….
•Core Items23• Overall
Assessment Items2
23 Items in 6 DomainsUSER’S MANUAL page 7
DOMAINS No. of Items
1 Scope & Purpose 3
2 Stakeholder Involvement 3
3 Rigour of Development 8
4 Clarity & Presentation 4
5 Applicability 3
6 Editorial Independence 2
Items and Domains: A Closer LookAGREE II:
USER’S MANUAL
Per each Domain (guidance for rating the 23 items) Pages 11 – 41
User’s Manual Description:Where to Look:How to Rate: Item content includes the following CRITERIA:Additional CONSIDERATIONS:
Domain 1
DOMAIN 1. SCOPE AND PURPOSE
1. Objective(s):Health impact & benefits of a CPG
on target populationIntroduction, scope, purpose,
rationale, background & objectives
2. Health Question(s):-Questions, Scope, Purpose, Rationale
and Background 3. Target population:-Pt. population, target population,
relevant pt.s, scope and purpose
DOMAIN 1. SCOPE AND PURPOSE
Domain 2
4. Guideline groupMethods, guideline panel list, acknowledgements,
& appendices
5. Patient preference Scope, methods, guideline panel list, external
review &target population perspectives
6. Target usersTarget user & intended user
DOMAIN 2. STAKEHOLDER INVOLVEMENT
Domain 3
7. Systematic methods for E search
8. Selection Criteria of E9. Strengths & Limitations of E10. Methods of Rs 11. Benefits , side effect and risks
in Rs12. Evidence Links (Gs of Rs – LoE)13. External Review 14. Update Procedure
DOMAIN 3. RIGOUR OF DEVELOPMENTMethods, literature search strategy & appendices+ inclusion/ exclusion criteria+ Evidence tables, clinical evidence, evidence description (results), evidence interpretation (discussion)Methods, CPG Development process same sections+ Rs, Key Evidence+ acknowledgements+ CPG update, date of CPG
Domain 4
DOMAIN 4. CLARITY OF PRESENTATION
15. Rs are specific Rs & executive summary
16. Options for management + discussion, Treatment (options/alternatives)
17. Recommendation identifiableKey Rs; separate (e.g. QRG)
Domain 5
DOMAIN 5. APPLICABILITY
18. Facilitators & barriers CPG dissemination/ implementation, barriers,
CPG utilization & Quality indicators
19. Tools+ tools, resources, appendices
20. Resource implicationsMethod, cost utility, cost effectiveness,
acquisition costs & implications for budgets
21. Monitoring /audit criteria Rs, Quality indicators & audit criteria
Domain 6
DOMAIN 6. EDITORIAL INDEPENDENCE
22. Funding bodyDisclaimer & funding source
23. Competing interestsMethods, Conflicts of interest (COI),
CPG panel & appendices
Overall Assessment
OVERALL CPG ASSESSMENT 1. Rate the overall quality of this CPG
2. I would recommend this CPG for use
3. Notes
YES Yes ,with modification No
Using the AGREE II Instrument 27
Selected CPG
DomainsOverall
Is CPG Recommended
for use ?1 2 3 4 5 6
CPG 1
CPG 2
CPG 3
CPG 4
CPG 5
Finally AGREE II Domain Scores Colour Coding (Dr. Lubna Alansary)
< 40 % Red >41-70 Yellow >71 Green
AGREE Domains Scores Table
CPG 1: SIGN
CPG 2: EPR3
CPG 3: GINA
CPG 4: ICSI
CPG 5: Singapore MOH
Domain 1 60 % 74 % 45 % 61 % 42 %Domain 2 55 % 56 % 60 % 58 % 63 %Domain 3 92 % 83 % 79 % 38 % 43 %Domain 4 95 % 90 % 92 % 75 % 87 %Domain 5 70 % 82 % 80 % 33 % 58 %Domain 6 80 % 60 % 22 % 50 % 10 %
Graphical Representation
AGREE II rater concordance calculator(McMaster University)
My AGREE (soon Our AGREE)
My AGREE II Report PDF
The cycle of development, publication, and implementation of CPGs for CKDJoseph A Vassalotti. Implementation or translation into practice should contribute to the development of a subsequent guideline, primarily through health services research. Clinical decision support is shown as the implementation method that bridges the gap between the evidence synthesized by clinical practice guidelines and patient care delivered through the electronic health record. The three major components of information technology in health care are shown: the personal health record, the electronic health record, and the population health record. The arrows represent the flow of information. The arrow between the patient and the personal health record is mostly in the direction of the patient, as patient input into the electronic health record is currently limited
Acknowledgments
