Assessment of the Quality of Recommendations from 161 Clinical Practice Guidelines Using the Appraisal of Guidelines for Research and Evaluation – Recommendations Excellence (AGREE-REX) Instrument Shows There Is Room for Improvement
Notice bibliographique
Résumé
Abstract Background: A new tool, the AGREE-REX, was recently developed to support the development, reporting, and assessment of clinical practice guidelines' (CPGs) recommendations, and to complement the AGREE II tool. We assessed the credibility and implementability of 161 CPGs recommendations using the AGREE-REX draft tool. Methods: Cross sectional study. CPGs were assessed by two independent appraisers using the AGREE-REX draft tool. The CPGs were rated with the tool's 7-point response scale for each item. Differences between CPGs according to country, year and type of organization (government-supported/professional society) were evaluated. One-way ANOVA tests were used to examine differences in the score. Results: Recommendations from 161 CPGs from 70 organizations were appraised by 322 participants from 51 countries, using the AGREE-REX draft tool. The total overall average score of the recommendations was 4.23 (standard deviation(SD)=1.14). AGREE-REX items that scored the highest were (mean; SD): Evidence (5.51; SD=1.14), Clinical relevance (5.95; SD=0.8), and Patients/population relevance (4.87; SD=1.33), while the lowest scores were observed for the Policy values (3.44; SD=1.53), Local applicability (3,56; SD=1.47) and Resources, tools and capacity (3.49; SD=1.44) items. CPGs developed by government-supported organizations and developed in the UK and Canada had significantly higher recommendation quality scores with the AGREE-REX tool (p=0.01) than their comparators. Conclusions: We found that there is significant room for improvement of some CPGs such as the considerations of patient/population values, policy values, local applicability and resources, tools and capacity. These findings may be considered a baseline upon which to measure future improvements in the quality of CPGs. Contribution to the literature · We applied the AGREE II and the recently developed tool (AGREE-REX draft version), to assess quality, credibility and implementability of 161 international clinical practice guidelines (CPGs). The AGREE REX draft tool was applied by 322 guidelines' developers, users and researchers from 51 countries.· The scores of the AGREE REX draft tool items were higher in those items related to the quality of the evidence and the clinical relevance. The items related to patients and population relevance and implementation relevance scored in the mid-range, while the items related to patients/population or policy values, the alignment of values, the local applicability, and the resouces, tools and capacity items scored low.· CPGs produced by government-supported organizations scored higher on all the items of the AGREE-REX draft tool than those produced by professional societies or other types of groups, and CPGs produced in United Kingdom and Canada scored higher in selected items in comparison to United States and international CPGs· The correlations between the overall AGREE-REX draft tool and AGREE II domains were low, except for the Applicability domain where the correlation was modest.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,256 | 0,414 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,004 | 0,006 |
| Bibliométrie | 0,013 | 0,007 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,003 | 0,004 |
| Science ouverte | 0,002 | 0,006 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; l’étiquette directe de Gemma et le classifieur distillé Codex s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».