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OriginIn recent years, many countries have built up experience in the development, appraisal and implementation of clinical practice guidelines at professional, institutional, regional and national levels, recognising that guidelines are key tools to improve the quality and appropriateness of health services. [1]

A number of national agencies, institutions, experts, and health care providers specialised in the guideline field are involved in supranational networks. This is apparent in the guidelines activities taking place all over the world. At the European level this has resulted in a Recommendation of the Council of Europe on Guidelines Methodology, [2] and in a generic methodology for guideline appraisal (AGREE Instrument). [3] On the American Continent, the US-National Guideline Clearinghouse was established. [4] In Australia and New Zealand, as well as in Asia and Africa, activities aiming at the use of good clinical practice guidelines are funded.

Despite these initiatives, there was no established forum for communication between those involved in developing, appraising and implementing clinical guidelines. As a result, in different countries aiming at similar goals and using similar strategies, efforts are unnecessarily reduplicated. By this, financial and structural resources might be wasted, and activities might be managed in a suboptimal way.

A major stimulus to international cooperation in guideline development in recent years has been the AGREE Collaboration, which was formed in 1998 to develop a common guideline appraisal instrument. Although the AGREE project was funded by the European Union (EU), from the outset it involved guideline developers and researchers from Canada, and soon expanded to include the United States and New Zealand, alongside fourteen European countries. The AGREE project highlighted the increasing harmonisation of the methodologies used by guideline agencies and programmes around the world, and the Collaboration itself provided a forum for guideline developers, researchers, and implementers to meet and share ideas.

Following completion of the initial AGREE project in 2001, delegates from Germany, the Netherlands, and the United Kingdom proposed during a meeting of the AGREE Collaboration in Barcelona, Spain to establish an International Guidelines Network to promote information sharing, cooperation and collaboration between guideline agencies, programmes, and individuals working in the field.

A survey was carried out to gauge the level of interest in systematic networking and define the organisational framework. For that purpose, a structured questionnaire was issued to national organisations working in the field of guideline production, appraisal, implementation and/or research. The questions addressed issues and areas the proposed network might work on as well as organisational aspects.

The study results (from 36 institutions in 18 countries) [5] were discussed during the International Guideline Conference of the German Agency for Quality in Medicine (ÄZQ) in June 2002 (Clinical Practice Guidelines 2002 Berlin), which formed the framework for a position paper presenting the background and objectives of a new organisation.



The foundation of the Network was initiated by a multinational Founding Committee (cf. Table 1). During summer 2002, the experts consented on the main objectives, areas of interest, and a possible working agenda for the network (cf. Table 2).

The Guidelines International Network (G-I-N) was founded in November 2002 on the premises of the National Federation of French Cancer Centers. Its Memorandum & Articles of Association was signed at the Royal College of Physicians of Edinburgh on February 4th, 2003.

The Guidelines International Network was formally constituted as a Scottish Guarantee Company under Company Number SC243691 and recognised as a Scottish Charity under Scottish Charity Number SC034047 and having its Registered Office in Scotland at J. & H. Mitchell W.S., 51 Atholl Road, Pitlochry, Perthshire PH16 5BU. It is managed by a Board of Trustees comprising representatives of many of the Member organisations and elected annually.

Until the 1st Annual General Meeting, November 2003 in Edinburgh, UK, the Founding Committee acted as Interim Board of Trustees. It then handed over to the first G-I-N Board which was elected by the membership.

Table 1: Founding Committee

Pim Assendelft

Finn B. Kristensen

Teus van Barneveld

Peter Littlejohns

Jako Burgers
(AGREE Collaboration)

Marjukka Mäkela

Bernard Burnand

Catherine Marshall
(NZGG, NZ - Vice Chair of the G-I-N Founding Committee)

Francoise Cluzeau
(AGREE Collaboration)

Juliet Miller

Davida De La Harpe

Günter Ollenschläger
(ÄZQ, DE - Chair of the G-I-N Founding Committee)

Albrecht Encke

Safia Qureshi

Béatrice Fervers

Rosa Rico Itturioz

Cindy Farquhar

Kitty Rosenbrand

Albert Jovell

Roland Schaffler
(, AT)

Minna Kaila
(Duodecim, FI)

Jean Slutsky

Table 2: Objectives of the Guidelines International Network (Memorandum of G-I-N)

The object of the network is to protect the health of the general public by seeking to improve the quality of healthcare

  • To promote the systematic development, dissemination, implementation and evaluation of clinical practice guidelines.
  • To promote international collaboration in guideline activities to avoid duplication of effort and to facilitate information-sharing, education and knowledge transfer.
  • To improve and, as appropriate, to harmonise methodologies for systematic guideline development, dissemination, implementation and evaluation.
  • To identify priorities for and to support research relating to clinical practice guidelines and to facilitate the implementation of research findings into practice relative to the object.
  • To build links between relevant international organisations so as to improve co-ordination with clinical practice guidelines and other healthcare quality initiatives.
  • To maintain a database of information of and relating to member organisations, their work programmes, methodologies and background documentation.
  • To prepare and organise, promote and implement training courses, exhibitions, lectures, seminars, conferences, events and workshops and to prepare, produce, edit, publish, exhibit and distribute articles.
  1. Burgers JS, Grol R, Klazinga NS, Mäkelä M, Zaat J, for the AGREE Collaboration. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs. Int J Qual Health Care 2003;15:31-45.
  2. Council of Europe. Developing a methodology for drawing up guidelines on best medical practice. Recommendation Rec(2001)13 and explanatory memorandum. Strasbourg: Council of Europe Publishing, 2002.
    Full text
  3. The AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care 2003;12:18-23
  4. The National Guideline Clearinghouse.
  5. Miller J, Ollenschläger G. Globalisation of CPGs: Do we need an international guidelines network? Presentation, International Guideline Congress CPG2002, Berlin.
    Clinical Practice Guidelines 2002 (CPG2002)
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