AGREE II Instrument

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AGREE History

Since 2003, the AGREE Enterprise has contributed to the science and advancement of practice guidelines through its various programs of research and international collaborations.

 The Original AGREE Instrument
The original AGREE Instrument was published in 2003 by a group of international guideline developers and researchers, the AGREE Collaboration. The objective of the Collaboration was to develop a tool to assess the quality of guidelines. The original AGREE Instrument, a 23-item tools comprising six quality domains, was translated into many languages, cited in well over 600 publications, and was endorsed by several health care organizations. As with any new assessment tool, it was recognized that ongoing development was required to strengthen the measurement properties of the instrument and ensure its usability among intended users.

The AGREE Research Trust
The AGREE Research Trust (ART) was established in July 2004 to facilitate the distribution, maintenance and improvement of the AGREE Instrument and to encourage its development through collaborative research projects. ART was a charitable trust, registered with Charity Commission for England and Wales and run by an international group of five trustees. ART was formally dissolved in July 2014.

Several members of the AGREE Collaboration formed the AGREE Next Steps Research Consortium to further improve the reliability and validity of the AGREE Instrument; to refine the instrument’s items to better meet the needs of intended users; and to develop a user’s manual to facilitate the ability of users to apply the instrument with confidence. This work was funded by the Canadian Institutes of Health Research (CIHR) and was led by Dr. Melissa Brouwers of McMaster University, Canada and an international team of co-investigators. The results of these efforts was the AGREE II, which was published in 2010, replacing the original AGREE instrument.

Following the release of the AGREE II, the AGREE A3 (Application, Appropriateness, Action) project team developed and tested an online training video with a virtual coach and an online interactive AGREE II appraisal practice exercise to accelerate the capacity of stakeholders to use and apply the AGREE II. In addition, the AGREE Reporting Checklist was created in 2016 based on the content and structure of the AGREE II to assist practice guideline developers to improve the completeness and transparency of reporting in their practice guidelines.

The AGREE II user’s manual has been periodically updated since its public release in 2009 to incorporate additional guidance requested by users and to update references and website links. The core content of the AGREE II tool has not been modified since 2009 and therefore all versions remain suitable for use.

Development of My AGREE PLUS
A group of international AGREE II users and guideline developers was assembled to develop a user-informed online AGREE II appraisal platform. This project was co-led by Minervation <add link>, a website development organization based in the UK with a specific focus on evidence-based healthcare information. The My AGREE PLUS platform was launched in 2013 and now has more than 30,000 registered users from around the world.

10 Years of AGREE (2003-2013)
2013 marked the 10 year anniversary of the release of the original AGREE Instrument. In celebration, a short report was published in Implementation Science outlining the successes and future steps of the AGREE Enterprise.

Recognizing that the AGREE II addresses the overall methodological quality and reporting of clinical practice guidelines but not the clinical credibility or implementability of their recommendations, additional funding was secured from CIHR to support the development of additional tools related to quality and implementability of guideline recommendations. In collaboration with the KT Canada Guideline Implementation Project led by Dr. Onil Bhattacharyya, a framework of intrinsic factors affecting clinical practice guideline implementability, called the Guideline Implementability for Decision Excellence Model (GUIDE-M), was developed and published in 2015. Building on components of the GUIDE-M, an international research team developed the AGREE Recommendation EXcellence (AGREE-REX) tool to evaluate the quality and implementability of clinical practice guideline recommendations. The AGREE-REX was released in 2018 and is a complement to the AGREE II.

Health systems guidance provides recommendations addressing health system challenges (e.g., health system governance, financial arrangements, and design and delivery of health programs and services. Given that no tool existed to evaluate the quality of health systems guidance or to direct its development and reporting, funding was sought from CIHR to create such a resource. The resulting tool, the AGREE Health Systems (AGREE-HS) was published in 2018.