Assessment of the quality of recommendations from 161 clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation–Recommendations Excellence (AGREE-REX) instrument shows there is room for improvement

Implementation Science

Amir Qaseem¹  Karen Spithoff²  Kate Kerkvliet²  Ivan D. Florez³  Jako Burgers⁴  Beatrice Férvers⁵  Steven Hanna⁶  Pablo Alonso-Coello⁷  Francoise Cluzeau⁸  Michelle Kho⁹  Sharon Straus^1,10  Monika Kastner^1,11  Ian Graham^1,12  Jeremy Grimshaw^1,12  Melissa C. Brouwers^1,13 

[1] American College of Physicians, 190 N Independence Mall West, 19106-1572, Philadelphia, PA, USA;Department of Oncology, McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, L8S 4L8, Hamilton, Ontario, Canada;Department of Pediatrics, Universidad de Antioquia, Calle 67 # 53-108, 050001, Medellin, Colombia;Department of Oncology, McMaster University, Juravinski Site, G2 Wing, 1280 Main Street West, L8S 4L8, Hamilton, Ontario, Canada;Dutch College of General Practitioners, PO Box 3231, Utrecht, The Netherlands;Département Cancer et Environnement, Centre Léon Bérard, 28 rue Laënnec, 69373, Cedex 08, Lyon, France;Faculty of Health Sciences, McMaster University, 2C Health Sciences Centre, 1280 Main Street West, L8S 4L8, Hamilton, Ontario, Canada;Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni M. Claret 167, Pavelló 18 planta 0, 08025, Barcelona, Spain;Imperial College London, St. Mary’s Hospital (Room 1070, Queen Elizabeth the Mother Wing), Praed Street, W2 1NY, London, UK;Institute of Applied Health Sciences McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, Ontario, Canada;Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Shuter 2-026, M5B 1W8, Toronto, Ontario, Canada;North York General Hospital, 4001 Leslie Street, M2K 1E1, Toronto, Ontario, Canada;Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Box 711, K1H 8L6, Ottawa, Ontario, Canada;School of Epidemiology and Public Health, University of Ottawa, 101F, 600 Peter Morand, K1G 5Z3, Ottawa, Ontario, Canada;

关键词: Clinical practice guidelines;    Practice guidelines;    Recommendations;    Quality of health care;    AGREE tool;    Implementability;   

DOI  :  10.1186/s13012-020-01036-5

来源: Springer

【 摘 要 】

ObjectiveTo assess the quality of recommendations from 161 clinical practice guidelines (CPGs) using AGREE-REX-D (Appraisal of Guidelines REsearch and Evaluation-Recommendations Excellence Draft).DesignCross-sectional studySettingInternational CPG community.ParticipantsThree hundred twenty-two international CPG developers, users, and researchers.InterventionParticipants were assigned to appraise one of 161 CPGs selected for the study using the AGREE-REX-D toolMain outcome measuresAGREE-REX-D scores of 161 CPGs (7-point scale, maximum 7).ResultsRecommendations from 161 CPGs were appraised by 322 participants using the AGREE-REX-D. CPGs were developed by 67 different organizations. The total overall average score of the CPG recommendations was 4.23 (standard deviation (SD) = 1.14). AGREE-REX-D items that scored the highest were (mean; SD): evidence (5.51; 1.14), clinical relevance (5.95; SD 0.8), and patients/population relevance (4.87; SD 1.33), while the lowest scores were observed for the policy values (3.44; SD 1.53), local applicability (3,56; SD 1.47), and resources, tools, and capacity (3.49; SD 1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX-D tool (p < 0.05) than their comparators.ConclusionsWe found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools, and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs.

【 授权许可】

CC BY