Knowing What Works in Health Care: A Roadmap for the Nation (2008)

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Appendix F Guideline Standards: The AGREE Instrument and COGS Checklist THE APPRAISAL OF GUIDELINES RESEARCH AND EVALUATION (AGREE) INSTRUMENT Scope and Purpose 1. The overall objective(s) of the guideline is (are) specifically described. 2. The clinical question(s) covered by the guideline is (are) specifically described. 3. The patients to whom the guideline is meant to apply are specifically described. Stakeholder Involvement 4. The guideline development group includes individuals from all the relevant professional groups. 5. The patients’ views and preferences have been sought. 6. The target users of the guideline are clearly defined. 7. The guideline has been piloted among target users. Rigour of Development 8. Systematic methods were used to search for evidence. 9. The criteria for selecting the evidence are clearly described. 10.  The methods used for formulating the recommendations are clearly described.   Reprinted in adapted format, with permission, from the AGREE Research Trust http:// www.agreetrust.org. Copyright 2006 by the AGREE Research Trust. 231 

232 KNOWING WHAT WORKS IN HEALTH CARE 11. The health benefits, side effects and risks have been considered in formulating the recommendations. 12. There is an explicit link between the recommendations and the sup- porting evidence. 13. The guideline has been externally reviewed by experts prior to its publication. 14. A procedure for updating the guideline is provided. Clarity and Presentation 15. The recommendations are specific and unambiguous. 16. The different options for management of the condition are clearly presented. 17. Key recommendations are easily identifiable. 18. The guideline is supported with tools for application. Applicability 19. The potential organisational barriers in applying the recommenda- tions have been discussed. 20. The potential cost implications of applying the recommendations have been considered. 21. The guideline presents key review criteria for monitoring and/or audit purposes. Editorial Independence 22. The guideline is editorially independent from the funding body. 23. Conflicts of interest of guideline development members have been recorded. 

APPENDIX F 233 CONFERENCE ON GUIDELINES STANDARDIZATION (COGS) CHECKLIST FOR REPORTING CLINICAL PRACTICE GUIDELINES Topic Description   1.  verview material O Provide a structured abstract that includes the guideline’s release date, status (original, revised, updated), and print and electronic sources.   2.  ocus F Describe the primary disease/condition and intervention/service/technology that the guideline addresses. Indicate any alternative preventive, diagnostic or therapeutic interventions that were considered during development.   3.  oal G Describe the goal that following the guideline is expected to achieve, including the rationale for development of a guideline on this topic.   4.  sers/setting U Describe the intended users of the guideline (e.g., provider types, patients) and the settings in which the guideline is intended to be used.   5.  arget population T Describe the patient population eligible for guideline recommendations and list any exclusion criteria.   6.  eveloper D Identify the organization(s) responsible for guideline development and the names/ credentials/potential conflicts of interest of individuals involved in the guideline’s development.   7.  unding F Identify the funding source/sponsor and source/sponsor describe its role in developing and/or reporting the guideline. Disclose potential conflict of interest.   8.  vidence E Describe the methods used to search the Collection scientific literature, including the range of dates and databases searched, and criteria applied to filter the retrieved evidence.   Reprinted, with permission, from Annals of Internal Medicine 2003. Copyright 2007 by the American College of Physicians. 

234 KNOWING WHAT WORKS IN HEALTH CARE Topic Description   9.  ecommendation R Describe the criteria used to rate the quality of grading criteria evidence that supports the recommendations and the system for describing the strength of the recommendations. Recommendation strength communicates the importance of adherence to a recommendation and is based on both the quality of the evidence and the magnitude of anticipated benefits or harms. 10.  ethod for M Describe how evidence was used to create synthesizing recommendations, e.g., evidence tables, meta- evidence analysis, decision analysis. 11.  rerelease review P Describe how the guideline developer reviewed and/or tested the guidelines prior to release. 12.  pdate plan U State whether or not there is a plan to update the guideline and, if applicable, an expiration date for this version of the guideline. 13.  efinitions D Define unfamiliar terms and those critical to correct application of the guideline that might be subject to misinterpretation. 14.  ecommendations R State the recommended action precisely and and rationale the specific circumstances under which to perform it. Justify each recommendation by describing the linkage between the recommendation and its supporting evidence. Indicate the quality of evidence and the recommendation strength, based on the criteria described in 9. 15.  otential benefits P Describe anticipated benefits and potential and harms risks associated with implementation of guideline recommendations. 16.  atient P Describe the role of patient preferences when a preferences recommendation involves a substantial element of personal choice or values. 17.  lgorithm A Provide (when appropriate) a graphical description of the stages and decisions in clinical care described by the guideline. 

APPENDIX F 235 Topic Description 18.  mplementation I Describe anticipated barriers to application of considerations the recommendations. Provide reference to any auxiliary documents for providers or patients that are intended to facilitate. REFERENCES The AGREE Collaboration. 2001. The Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. London, UK: The AGREE Research Trust http://www.agreetrust. org/docs/AGREE_Instrument_English.pdf (accessed September 2007). Shiffman, R. N., P. Shekelle, M. Overhage, J. Slutsky, J. Grimshaw, and A. M. Deshpande. 2003. Standardized reporting of clinical practice guidelines: A proposal from the Confer- ence on Guideline Standardization. Annals of Internal Medicine 139(6):493-500.