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Development of the AGREE II, part 1: performance, usefulness and areas for improvement

Overview
Title:
Development of the AGREE II, part 1: performance, usefulness and areas for improvement
Authors:
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Hanna SE, Makarski J
Journal:
CMAJ
Publication date:
2010
Volume:
182
Issue:
10
First page:
1045
Last page:
52
ISSN:
1488-2329
Link to pubmed:
http://www.ncbi.nlm.nih.gov/pubmed/20513780
Link to full text:
http://www.cmaj.ca/cgi/content/full/182/10/1045
Publication type:
Journal
Free text

Background: We undertook research to improve the AGREE instrument, a tool used to evaluate guidelines. We tested a new seven-point scale, evaluated the usefulness of the original items in the instrument, investigated evidence to support shorter, tailored versions of the tool, and identified areas for improvement. Method: We report on one component of a larger study that used a mixed design with four factors (user type, clinical topic, guideline and condition). For the analysis reported in this article, we asked participants to read a guideline and use the AGREE items to evaluate it based on a seven-point scale, to complete three outcome measures related to adoption of the guideline, and to provide feedback on the instrument’s usefulness and how to improve it. Results: Guideline developers gave lower-quality ratings than did clinicians or policy-makers. Five of six domains were significant predictors of participants’ outcome measures (p < 0.05). All domains and items were rated as useful by stakeholders (mean scores > 4.0) with no significant differences by user type (p > 0.05). Internal consistency ranged between 0.64 and 0.89. Interrater reliability was satisfactory. We received feedback on how to improve the instrument. Interpretation: Quality ratings of the AGREE domains were significant predictors of outcome measures associated with guideline adoption: guideline endorsements, overall intentions to use guidelines, and overall quality of guidelines. All AGREE items were assessed as useful in determining whether a participant would use a guideline. No clusters of items were found more useful by some users than others. The measurement properties of the seven-point scale were promising. These data contributed to the refinements and release of the AGREE II.

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Development of the AGREE II, part 1: performance, usefulness and areas for improvement Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G et al. CMAJ 2010; 182(10):1045-52.

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