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Clinical Practice Guidelines: Appraising

This is a guide to help students and faculty find clinical practice guidelines.

Why assess quality?

Not all guidelines are created equal. The end result is only as good as the process that went into creating the guideline. Guidelines impact patient care, safety, and healthcare quality. It is important to understand whether the guideline is a valuable piece of practice advice.

If you are finding CPGs for an in-class assignment, your instructor will likely assign an appraisal tool for you to work with. Please see examples below.

AGREE

Appraisal of Guidelines for Research & Evaluation II (AGREE II)

Developed in 2010, and based on the earlier AGREE tool, AGREE II is an internationally recognized method used to assess the quality and reporting of practice guidelines. However, AGREE II does not address the clinical validity of practice guideline recommendations. 

Use AGREE II to evaluate a guideline based on 6 domains:

  1. Scope and purpose
  2. Stakeholder involvement
  3. Rigor of development
  4. Clarity of presentation
  5. Applicability
  6. Editorial Independence

National Academy of Medicine

As part of the "Clinical Practice Guidelines We can Trust" initiative, the National Academy of Medicine (previously the Institute of Medicine or IOM) developed 8 standards for developing trustworthy clinical practice guidelines that look at:

  1. Establishing transparency
  2. Management of conflict of interest
  3. Guideline development group composition
  4. GPG - systematic review intersection
  5. Establishing evidence foundations for and rating strength of recommendations
  6. Articulation of recommendations
  7. External review
  8. Updating

The National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) Instrument is used to assess how well a CPG adheres to the 8 standards.

GUIDE - M

The Guideline Implementability for Decision Excellence Model (GUIDE - M) seeks to:

  • Optimize the implementability of CPGs
  • Facilitate the creation of CPGs optimized for implementability
  • Help clinicians be better consumers of CPGs
  • Identify knowledge gaps and priorities for further research