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
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.256 | 0.414 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.013 | 0.007 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".