AGREE II Instrument

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AGREE-HS Instructions

The AGREE-HS is intended for application to health systems guidance (HSG) documents. HSG documents provide recommendations related to improving health system governance, or financial or delivery arrangements. Relevant documents might not be labeled as “HSG”; generally, if a document addresses a health systems challenge and provides recommendations or statements of action, it can be appraised with the AGREE-HS

Users of the AGREE-HS Tool

Guidance developers

  • To use as a structured, systematic and standardized methodological framework for developing and reporting HSG

Policy makers and program managers

  • To evaluate the quality of the HSG that is recommended for use
  • To inform policy development and implementation
  • To enhance policy monitoring and evaluation

Stakeholders (including patients/consumers, health professionals, researchers, educators and other stakeholders interested in the development and uptake of HSG)

  • To enhance their skills in the development, reporting and critical appraisal of HSG

Structure and Contents of the AGREE-HS Tool

The AGREE-HS is comprised of five items representing key HSG quality domains:

  1. Topic;
  2. Participants;
  3. Methods; and
  4. Recommendations and implementability

Each item also contains:

  • Definition of the item
  • Quality criteria for the item
  • 7-point response scale for assessment (1=strongly disagree; 7 = strongly agree)

The AGREE-HS also has two overall assessment questions to consider when making an overall judgement about the HSG document. Both of these assessment questions are rated as ‘yes’, ‘yes with modifications’, or ‘no’.

Appraisal Process of the AGREE-HS Tool

  • It is recommended that at least two, and preferably four, appraisers review each HSG to increase the reliability of the assessment
  • Before applying the tool, users should read the HSG document in full, as well as any accompanying documents
  • 2 scoring methods
    • Method 1: using individual appraisers’ scores
    • Method 2: reaching consensus
  • Purpose of scoring:
    • To identify limitations of the HSG being considered
    • To select high quality HSG to implement
  • Interpreting scores:
    • The manual does not weigh final item scores, nor does it define a threshold overall score to differentiate between high, moderate and low quality HSG, as there is no empirical basis to define thresholds; however, examples of how the scores can be interpreted are described

Additional information can be found in the AGREE-HS tool, download it here.

If you have additional questions about the AGREE-HS, please contact us.