AGREE II Instrument: Assessment of the Quality of Clinical Practice Guidelines

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The AGREE II Instrument was developed by staff from McMaster University in Canada (where the father of EBM Prof Dr David Sackett came from)

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AGREE II Instrument: Assessment of the Quality of Clinical Practice Guidelines

  1. 1. InstructorDr. Yasser Sami AmerMS Pediatrics, MS Healthcare InformaticsCPGs General Coordinator, KSUHs, AUHsMember, G-I-N Adaptation & GIRAnet Working Groups
  2. 2. PurposeTo guide on how to use and apply theAGREE II for assessing CPGSItemsDomainsUser’s Manual
  3. 3. Outlines• Overview of AGREE II including the items anddomains.• Present the scoring method of the CPG.• How to use and apply the AGREE II forassessing CPG.• Share the overall scoring.
  4. 4. What is the AGREE II Tool ?• Quality (Methodological rigor & transparency; confident inresulting Recommendations)4 Using the AGREE II InstrumentAssessGuide•CPGs Development•CPGs ReportingHistory1st AGREE was published in 2003,then refined in 2009 AGREE II(New scoring “7 point scale” – Items modifications – Newuser’s manual)Can be applied to anyCPG in any Diseasearea !
  5. 5. • Healthcare providers• CPG developers/ adapters• Policy makers• EducatorsWho can use the AGREE II ?
  6. 6. Considerations before a CPGAssessment• increase the reliability of the assessment2 – 4 Appraisers• in full and obtain all related information andneeded documents before undertaking theAGREE II assessment ( to make a wellinformed assessment)Read CPG first
  7. 7. Rating Scale• All AGREE II Items are rated on the following 7-point scaleScore Meaning7 (StronglyAgree)= If the quality of reporting is exceptional and full criteriaand considerations in User’s manual are met.1 (StronglyDisagree)= No information relevant to AGREE II item OR the conceptis very poorly reported2 – 6 = when the reporting of the item does not meet the fullcriteria or considerations, depending on the completeness& quality of reporting .
  8. 8. The AGREE II Includes….•Core Items23•OverallAssessment Items2
  9. 9. 23 Items in 6 DomainsUSER’S MANUAL page 7DOMAINS No. of Items1 Scope & Purpose 32 Stakeholder Involvement 33 Rigour of Development 84 Clarity & Presentation 45 Applicability 36 Editorial Independence 2
  10. 10. Items and Domains: A Closer LookAGREE II:USER’S MANUALPer 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:
  11. 11. Domain 1
  12. 12. DOMAIN 1. SCOPE AND PURPOSE1. Objective(s):Health impact & benefits of a CPGon target populationIntroduction, scope, purpose,rationale, background & objectives
  13. 13. 2. Health Question(s):-Questions, Scope, Purpose, Rationaleand Background3. Target population:-Pt. population, target population,relevant pt.s, scope and purposeDOMAIN 1. SCOPE AND PURPOSE
  14. 14. Domain 2
  15. 15. 4. Guideline groupMethods, guideline panellist, acknowledgements, & appendices5. Patient preferenceScope, methods, guideline panel list, externalreview &target population perspectives6. Target usersTarget user & intended userDOMAIN 2. STAKEHOLDERINVOLVEMENT
  16. 16. Domain 3
  17. 17. 7. Systematic methods for Esearch8. Selection Criteria of E9. Strengths & Limitations of E10. Methods of Rs11. Benefits , side effect and risksin Rs12. Evidence Links (Gs of Rs –LoE)13. External Review14. Update ProcedureDOMAIN 3. RIGOUR OF DEVELOPMENTMethods, literature searchstrategy & appendices+ inclusion/ exclusion criteria+ Evidence tables, clinicalevidence, evidence description(results), evidenceinterpretation (discussion)Methods, CPG Developmentprocess same sections+ Rs, Key Evidence+ acknowledgements+ CPG update, date of CPG
  18. 18. Domain 4
  19. 19. DOMAIN 4. CLARITY OF PRESENTATION15. Rs are specificRs & executive summary16. Options for management+ discussion, Treatment (options/alternatives)17. Recommendation identifiableKey Rs; separate (e.g. QRG)
  20. 20. Domain 5
  21. 21. DOMAIN 5. APPLICABILITY18. Facilitators & barriersCPG dissemination/implementation, barriers, CPG utilization &Quality indicators19. Tools+ tools, resources, appendices20. Resource implicationsMethod, cost utility, costeffectiveness, acquisition costs & implicationsfor budgets
  22. 22. Domain 6
  23. 23. DOMAIN 6. EDITORIAL INDEPENDENCE22. Funding bodyDisclaimer & funding source23. Competing interestsMethods, Conflicts of interest (COI),CPG panel & appendices
  24. 24. Overall Assessment
  25. 25. OVERALL CPG ASSESSMENT1. Rate the overall quality of this CPG2. I would recommend this CPG for use3. NotesYESYes ,with modificationNo
  26. 26. Using the AGREE II Instrument 27
  27. 27. SelectedCPGDomainsOverallIs CPGRecommendedfor use ?1 2 3 4 5 6CPG 1CPG 2CPG 3CPG 4CPG 5Finally AGREE II Domain Scores Colour Coding (Dr. Lubna Alansary)< 40 % Red >41-70 Yellow >71 Green
  28. 28. AGREEDomainsScores TableCPG 1:SIGNCPG 2:EPR3CPG 3:GINACPG 4:ICSICPG 5:Singapore MOHDomain 160 % 74 % 45 % 61 % 42 %Domain 255 % 56 % 60 % 58 % 63 %Domain 392 % 83 % 79 % 38 % 43 %Domain 495 % 90 % 92 % 75 % 87 %Domain 570 % 82 % 80 % 33 % 58 %Domain 680 % 60 % 22 % 50 % 10 %
  29. 29. Graphical Representation
  30. 30. AGREE II rater concordance calculator(McMaster University)
  31. 31. AGREE Enterprise websitehttp://www.agreetrust.org/
  32. 32. My AGREE (soon Our AGREE)
  33. 33. My AGREE II Report PDF
  34. 34. The cycle of development, publication, and implementation of CPGs for CKDJoseph A Vassalotti. Implementation or translation into practice should contribute to the development of asubsequent guideline, primarily through health services research. Clinical decision support is shown as theimplementation method that bridges the gap between the evidence synthesized by clinical practice guidelines andpatient care delivered through the electronic health record. The three major components of information technologyin 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 ismostly in the direction of the patient, as patient input into the electronic health record is currently limited
  35. 35. Acknowledgments
  36. 36. Dr. Yasser Sami AmerMSc Pediatrics, MSc HC InformaticsEBCPGs Advisor & Traineryasser3amer@yahoo.com

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