AGREE II Instrument

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AGREE Next Steps

AGREE Next Steps: Continuous Quality Improvement in the Evaluation of Practice Guidelines

The AGREE Next Steps project aimed to further refined the AGREE Instrument.  The overall objective of this project was to facilitate the next iteration of the AGREE Instrument by conducting research to improve its psychometric properties, in particular to establish its validity and to test its utility.

Phase 1 of the project provided insight in the AGREE Instrument from various user groups:  practice guideline developers/researchers, clinicians, and policy/decision makers.   The AGREE Next Steps Research Consortium used this data to create an updated version of the AGREE Instrument (i.e., beta-AGREE II).

Phase II of the project involved further testing the measurement properties of the updated AGREE Instrument, or beta-AGREE II.

The result of this project is the new AGREE II, which includes a new User’s Manual.  The AGREE II consists of 23 items grouped into the same six domains as the original AGREE Instrument and has a new 7-point scale.

Approximately one third of the original items have been modified, domain structures have been altered, and an extensive restructuring of the accompanying training materials (e.g., original users guide and training manual) was undertaken.


In addition, through the AGREE Next Steps project, we developed and evaluated the AGREE Global Rating Scale Instrument(AGREE GRS).

The AGREE GRS Instrument is a short item tool based on the AGREE II tool. The AGREE GRS Instrument can be used in place of the AGREE II, for example, when time and resources are limited and the application of a more comprehensive tool is not feasible.

Of note, our study found that the overall quality measures and outcome scores did not vary between those who applied the AGREE GRS alone and those who applied both the AGREE GRS and AGREE II.   The most common feedback received via written comments was to provide more detail for the AGREE GRS’s items, however, that detail is already included in the AGREE II.

Full details of the AGREE GRS Instrument and the evaluation study are included in the paper published in the Journal of Clinical Epidemiology:

Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. The Global Rating Scale complements the AGREE II in advancing the quality of practice guidelines. J Clin Epidemiol 2012 MAY;65(5):526-534.

To access the “AGREE GRS”, click here.

*The GRS is pre-fixed by “AGREE II” to relate it to the AGREE Enterprise and to distinguish it from other global rating scales that exist (i.e., the UK-GRS, the endoscopy Global Rating Scale Canada (GRS-C))