The AGREE Instrument

The AGREE guideline appraisal instrument (available at http://www.agreecollaboration.org) provides a validated, internationally agreed framework for assessing the quality of clinical practice guidelines.

The appraisal criteria enable potential guideline users to carry out a structured evaluation of the guideline, together with any background documentation, in order to form a judgement as to whether the potential sources of bias inherent in guideline development have been minimised, and the likely validity of the guideline recommendations maximised.

Developing good guidelines - meeting the AGREE criteria

In order to use the AGREE instrument, appraisers need access to information on the process and methods used to develop the guideline. Guideline developers therefore need to be explicit and transparent about the methods they have used to create their guidelines so that users can then see with confidence that the potential biases of guideline development have been addressed adequately and that the recommendations are both internally and externally valid, and feasible for practice. Explicit recording of the processes used to develop the guideline allows appraisers to see that this is free of bias and that there is a clear link between the evidence and the recommendations contained in the guideline. It is important to emphasise that much of this information will not be found in the guideline itself, but may be produced in a separate technical report, detailed in methodology or policy documents, or made available on a website.

This guide provides background notes on the principles behind the AGREE appraisal criteria as applied by a number of national guideline development programmes, together with examples of how the information relevant to each of the criteria is made available for these guidelines.

Health Warning!

One final point for appraisers to bear in mind is that it is unlikely that any guidelines will meet all of the criteria in full: the AGREE criteria represent something of an ideal methodology, which guideline developers are striving to meet. However, by using this guide, we hope that those appraising guidelines against the AGREE criteria will find it easier to access the information required to make a fair and valid assessment.

Introduction