RT Journal Article
SR Electronic
T1 Development of the AGREE II, part 1: performance, usefulness and areas for improvement
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 1045
OP 1052
DO 10.1503/cmaj.091714
VO 182
IS 10
A1 Melissa C. Brouwers
A1 Michelle E. Kho
A1 George P. Browman
A1 Jako S. Burgers
A1 Francoise Cluzeau
A1 Gene Feder
A1 Béatrice Fervers
A1 Ian D. Graham
A1 Steven E. Hanna
A1 Julie Makarski
A1 for the AGREE Next Steps Consortium
YR 2010
UL http://www.cmaj.ca/content/182/10/1045.abstract
AB Background: We undertook research to improve the AGREE instrument, a tool used to evaluate guidelines. We tested a new seven-point scale, evaluated the usefulness of the original items in the instrument, investigated evidence to support shorter, tailored versions of the tool, and identified areas for improvement. Method: We report on one component of a larger study that used a mixed design with four factors (user type, clinical topic, guideline and condition). For the analysis reported in this article, we asked participants to read a guideline and use the AGREE items to evaluate it based on a seven-point scale, to complete three outcome measures related to adoption of the guideline, and to provide feedback on the instrument’s usefulness and how to improve it. Results: Guideline developers gave lower-quality ratings than did clinicians or policy-makers. Five of six domains were significant predictors of participants’ outcome measures (p < 0.05). All domains and items were rated as useful by stakeholders (mean scores > 4.0) with no significant differences by user type (p > 0.05). Internal consistency ranged between 0.64 and 0.89. Inter-rater reliability was satisfactory. We received feedback on how to improve the instrument. Interpretation: Quality ratings of the AGREE domains were significant predictors of outcome measures associated with guideline adoption: guideline endorsements, overall intentions to use guidelines, and overall quality of guidelines. All AGREE items were assessed as useful in determining whether a participant would use a guideline. No clusters of items were found more useful by some users than others. The measurement properties of the seven-point scale were promising. These data contributed to the refinements and release of the AGREE II.