AGREE II Instrument

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Practice Guidelines

A meeting

What are practice guidelines?

Practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances (1).

In addition, practice guidelines can play an important role in health policy formation (2,3) and have evolved to cover topics across the health care continuum (e.g. health promotion, screening, diagnosis).

Practice guidelines are evidence-based if they undertake a review of the literature and link their concluding recommendations to the evidentiary base identified through the literature search.

Authors of practice guidelines are usually experts in the content topic area and in research methodology.  Authors provide interpretation of the evidence and include their expertise to formulate the recommendations.

The potential benefits of practice guidelines are only as good as the quality of the practice guidelines themselves. Appropriate methods and rigorous strategies in the guideline development process are important for the successful implementation of the resulting recommendations (4-6).  The quality of guidelines can be extremely variable and some often fall short of basic standards (7-9).

The AGREE II is a valid and reliable tool that can be applied to any practice guideline in any disease area and can be used by health care providers, guideline developers, researchers, decision/policy makers, and educators.  The AGREE II can also serve as the foundational development framework when developing a new practice guideline.



  1. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J.  Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527-530.
  2. Committee to Advise the Public Health Service on Clinical Practice Guidelines IoM.  Clinical practice guidelines: directions for a new program. Washington: National Academy Press; 1990.
  3. Browman GP, Snider A, Ellis P. Negotiating for change. The healthcare manager as catalyst for evidence-based practice: changing the healthcare environment and sharing experience. Healthc Pap. 2003;3(3):10-22.
  4. Grol R. Success and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001;39(8 Suppl 2):1146-54.
  5. Davis DA, Taylor-Vaisey A. Translating guidelines into practice: a systematic review of theoretic concepts, practice experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997;157(4):408-16.
  6. Grimshaw J,.Russell I. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342:1317-22.
  7. Shaneyfelt TM, Mayo-Smith MF Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA 1999:281(20):1900-5.
  8. Grilli R, Magrini N, Penna A, Mura G, Liberati A. Practice guidelines developed by specialty societies: the need for critical appraisal. Lancet. 2000;355:103-6.
  9. Burgers JS, Fervers B, Haugh M, Brouwers M, Browman G, Phillip T, Cluzeau FA.  International assessment of the quality of clinical practice guidelines in oncology using the Appraisal of Guidelines and Research and Evaluation Instrument.  J Clin Oncol. 2004;22:2000-7.