This document provides an overview of the AGREE II tool for assessing clinical practice guidelines (CPGs). It outlines the 23 items across 6 domains that are used to rate CPGs, including scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Guidance is provided on how to use the 7-point scale to score each item based on criteria in the AGREE II user's manual. The document demonstrates applying the AGREE II to sample CPGs and generating an overall assessment and recommendation about using each CPG.

1. Instructor
Dr. Yasser Sami Amer
MS Pediatrics, MS Healthcare Informatics
CPGs General Coordinator, KSUHs, AUHs
Member, G-I-N Adaptation & GIRAnet Working Groups

2. Purpose
To guide on how to use and apply the
AGREE II for assessing CPGS
Items
Domains
User’s Manual

3. 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.

4. 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 !

5. • Healthcare providers
• CPG developers/ adapters
• Policy makers
• Educators
Who can use the AGREE II ?

6. 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

7. Rating Scale
• All AGREE II Items are rated on the following 7-point scale
Score Meaning
7 (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 .

8. The AGREE II Includes….
•Core Items
23
•Overall
Assessment Items2

9. 23 Items in 6 Domains
USER’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

10. Items and Domains: A Closer Look
AGREE 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:

11. Domain 1

12. DOMAIN 1. SCOPE AND PURPOSE
1. Objective(s):
Health impact & benefits of a CPG
on target population
Introduction, scope, purpose,
rationale, background & objectives

13. 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

14. Domain 2

15. 4. Guideline group
Methods, guideline panel
list, acknowledgements, & appendices
5. Patient preference
Scope, methods, guideline panel list, external
review &target population perspectives
6. Target users
Target user & intended user
DOMAIN 2. STAKEHOLDER
INVOLVEMENT

16. Domain 3

17. 7. Systematic methods for E
search
8. Selection Criteria of E
9. Strengths & Limitations of E
10. Methods of Rs
11. Benefits , side effect and risks
in Rs
12. Evidence Links (Gs of Rs –
LoE)
13. External Review
14. Update Procedure
DOMAIN 3. RIGOUR OF DEVELOPMENT
Methods, 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

18. Domain 4

19. DOMAIN 4. CLARITY OF PRESENTATION
15. Rs are specific
Rs & executive summary
16. Options for management
+ discussion, Treatment (options/alternatives)
17. Recommendation identifiable
Key Rs; separate (e.g. QRG)

20. Domain 5

21. DOMAIN 5. APPLICABILITY
18. Facilitators & barriers
CPG dissemination/
implementation, barriers, CPG utilization &
Quality indicators
19. Tools
+ tools, resources, appendices
20. Resource implications
Method, cost utility, cost
effectiveness, acquisition costs & implications
for budgets

22. Domain 6

23. DOMAIN 6. EDITORIAL INDEPENDENCE
22. Funding body
Disclaimer & funding source
23. Competing interests
Methods, Conflicts of interest (COI),
CPG panel & appendices

24. Overall Assessment

25. 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

27. Using the AGREE II Instrument 27

28. Selected
CPG
Domains
Overall
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

29. AGREE
Domains
Scores Table
CPG 1:
SIGN
CPG 2:
EPR3
CPG 3:
GINA
CPG 4:
ICSI
CPG 5:
Singapor
e 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 %

30. Graphical Representation

31. AGREE II rater concordance calculator
(McMaster University)

34. AGREE Enterprise website
http://www.agreetrust.org/

35. My AGREE (soon Our AGREE)

36. My AGREE II Report PDF

38. The cycle of development, publication, and implementation of CPGs for CKD
Joseph 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

39. Acknowledgments

40. Dr. Yasser Sami Amer
MSc Pediatrics, MSc HC Informatics
EBCPGs Advisor & Trainer
yasser3amer@yahoo.com