AGREE II Instrument

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AGREE History

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10 Years of AGREE (2003-2013)

This year marked the 10th Year anniversary of AGREE!  It is hard to believe 10 years have passed since the release of the original AGREE Instrument.

For your interest, we summarized the trajectory of AGREE Enterprise activity over the past 10 years and you may find that roadmap here.  Also, to mark the anniversary, we have updated the AGREE II (2009) document – please note, the core content of the AGREE II document was not touched; we simply added an update section, labeled “September 2013 Update”.

International Uptake and Use of AGREE
Since 2003, the AGREE Enterprise has contributed to the science and advancement of practice guidelines through its various programs of research and international collaborations. In addition to the efforts of the AGREE Enterprise, international efforts have lead to 32 language translations of the original and AGREE II, close to 600 articles that reference the AGREE tools, and the adoption by many groups and organizations of AGREE as the basis of their practice guideline development framework or as part of their educational training requirements..

The Place for All Things AGREE
The Website of the AGREE Enterprise, , is a popular one, averaging about 6,500 visits per month.  Over 6,000 individuals are registered users of the website and have used the My AGREE tool platform for their practice guideline appraisal activities.  Just recently, we launched a revised version of My AGREE, the new My AGREE PLUS – this new online platform meets the needs of users by offering a complete platform for undertaking group AGREE II appraisals of a practice guideline.   To facilitate the use of My AGREE PLUS, we posted several instructional videos that provide an overview of the platform and specific directions for how to use it. We thank our international user group development panel and Minervation for the excellent contributions they made to this project, which culminated in an effective and user-friendly final platform.

AGREE’s Programme of Research
Our research projects have resulted in the methodologically refined AGREE II (current version), the AGREE II online training tools and the development of the comprehensive framework, GUIDE-M.  Acknowledging that AGREE II does not address the clinical validity of practice guideline recommendations, our current research project will look to close that gap.  Specifically, using elements of GUIDE-M and beyond, we will develop and test a resource tool to guide the development, reporting and evaluation of the clinical credibility of practice guideline recommendations to optimize their implementability.

In Thanks….

We extend our thanks to everyone who has been a part of the AGREE Enterprise over the past 10 years. We continually welcome the queries we receive from the international community about the AGREE and its use.  We also value receiving emails about the various activities and efforts pertaining to AGREE.   Keep the communications coming!


The AGREE Collaboration

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 AGREE Collaboration defined quality of guidelines as the confidence that the potential biases of guideline development have been addressed adequately and that the recommendations are both internally and externally valid, and are feasible for practice.

The assessment includes judgments about the methods used for developing the guidelines, the components of the final recommendations, and the factors that are linked to their uptake.

The result of the Collaboration’s effort was the original AGREE Instrument, a 23-item tool comprising 6 quality domains.  The AGREE Instrument has been translated into many languages, has been cited in well over 100 publications, and is endorsed by several health care organizations.  More details about the original instrument and related publications are available here.

AGREE Next Steps Research Consortium

As with any new assessment tool, it was recognized that ongoing development was required to strengthen the measurement properties of the instrument and to ensure its usability and feasibility among intended users.  This led several members of the original team to form the AGREE Next Steps Research Consortium (Consortium).

The objectives of the Consortium were to further improve the measurement properties of the instrument, including its reliability and validity; to refine the instrument’s items to better meet the needs of the intended users; and to improve the supporting documentation (i.e., original training manual and user’s guide) to facilitate the ability of users to implement the instrument with confidence.

The result of these efforts is the AGREE II, which is comprised of the new User’s Manual and 23 item tool organized into the same six domains.

The User’s Manual is a significant modification of the original training manual and user’s guide and provides explicit information for each of the 23 items.  Table 1 compares the items of the original AGREE to the items in the AGREE II.

Comparison of AGREE with AGREE II

Original AGREE Item AGREE II Item
Domain 1. Scope and Purpose
1. The overall objective(s) of the guideline is (are) specifically described. No change
2. The clinical question(s) covered by the guideline is (are) specifically described. The health question(s) covered by the guideline is (are) specifically described.
3. The patients to whom the guideline is meant to apply are specifically described. The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described.
Domain 2. Stakeholder Involvement
4. The guideline development group includes individuals from all the relevant professional groups. No change
5. The patients’ views and preferences have been sought. The views and preferences of the target population (patients, public, etc.) have been sought.
6. The target users of the guideline are clearly defined. No change
7. The guideline has been piloted among end users. Delete item. Incorporated into user guide description of item 19.
Domain 3. Rigour of Development
8. Systematic methods were used to search for evidence. No change in item. Renumber to 7.
9. The criteria for selecting the evidence are clearly described. No change in item. Renumber to 8.
NEW Item 9. The strengths and limitations of the body of evidence are clearly described.
10. The methods for formulating the recommendations are clearly described. No change
11. The health benefits, side effects, and risks have been considered in formulating the recommendations. No change
12. There is an explicit link between the recommendations and the supporting evidence. No change
13. The guideline has been externally reviewed by experts prior to its publication. No change
14. A procedure for updating the guideline is provided. No change
Domain 4. Clarity of Presentation
15. The recommendations are specific and unambiguous. No change
16.The different options for management of the condition are clearly presented. The different options for management of the condition or health issue are clearly presented.
17. Key recommendations are easily identifiable. No change
Domain 5. Applicability
18. The guideline is supported with tools for application. The guideline provides advice and/or tools on how the recommendations can be put into practice. AND Change in domain (from Clarity of Presentation) AND renumber to 19
19. The potential organizational barriers in applying the recommendations have been discussed. The guideline describes facilitators and barriers to its application. AND change in order – renumber to 18
20. The potential cost implications of applying the recommendations have been considered. The potential resource implications of applying the recommendations have been considered.
21. The guideline presents key review criteria for monitoring and/ or audit purposes. The guideline presents monitoring and/ or auditing criteria.
Domain 6. Editorial Independence
22. The guideline is editorially independent from the funding body. The views of the funding body have not influenced the content of the guideline.
23.Conflicts of interest of guideline development members have been recorded. Competing interests of guideline development group members have been recorded and addressed.