InstructorDr. Yasser Sami Amer

MS Pediatrics, MS Healthcare InformaticsCPGs General Coordinator, KSUHs, AUHs

Member, G-I-N Adaptation & GIRAnet Working Groups

Purpose

To guide on how to use and apply the AGREE II for assessing CPGSItemsDomainsUser’s Manual

Outlines

• Overview of AGREE II including the items and

domains.

• Present the scoring method of the CPG.

• How to use and apply the AGREE II for assessing

CPG.

• Share the overall scoring.

What is the AGREE II Tool ?

• Quality (Methodological rigor & transparency; confident in resulting Recommendations)

4 Using the AGREE II Instrument

Assess

Guide •CPGs Development •CPGs Reporting

History 1st AGREE was published in 2003,then refined in 2009 AGREE II (New scoring “7 point scale” – Items modifications – New user’s manual)

Can be applied to any CPG in any Disease area !

• Healthcare providers

• CPG developers/ adapters

• Policy makers

• Educators

Who can use the AGREE II ?

Considerations before a CPG Assessment

• increase the reliability of the assessment

2 – 4 Appraisers

• in full and obtain all related information and needed documents before undertaking the AGREE II assessment ( to make a well informed assessment)

Read CPG first

Rating Scale• All AGREE II Items are rated on the following 7-point scale

Score Meaning7 (Strongly Agree)

= If the quality of reporting is exceptional and full criteria and considerations in User’s manual are met.

1 (Strongly Disagree)

= No information relevant to AGREE II item OR the concept is very poorly reported

2 – 6 = when the reporting of the item does not meet the full criteria or considerations, depending on the completeness & quality of reporting .

The AGREE II Includes….

•Core Items23• Overall

Assessment Items2

23 Items in 6 DomainsUSER’S MANUAL page 7

DOMAINS No. of Items

1 Scope & Purpose 3

2 Stakeholder Involvement 3

3 Rigour of Development 8

4 Clarity & Presentation 4

5 Applicability 3

6 Editorial Independence 2

Items and Domains: A Closer LookAGREE II:

USER’S MANUAL

Per each Domain (guidance for rating the 23 items) Pages 11 – 41

User’s Manual Description:Where to Look:How to Rate: Item content includes the following CRITERIA:Additional CONSIDERATIONS:

Domain 1

DOMAIN 1. SCOPE AND PURPOSE

1. Objective(s):Health impact & benefits of a CPG

on target populationIntroduction, scope, purpose,

rationale, background & objectives

2. Health Question(s):-Questions, Scope, Purpose, Rationale

and Background 3. Target population:-Pt. population, target population,

relevant pt.s, scope and purpose

DOMAIN 1. SCOPE AND PURPOSE

Domain 2

4. Guideline groupMethods, guideline panel list, acknowledgements,

& appendices

5. Patient preference Scope, methods, guideline panel list, external

review &target population perspectives

6. Target usersTarget user & intended user

DOMAIN 2. STAKEHOLDER INVOLVEMENT

Domain 3

7. Systematic methods for E search

8. Selection Criteria of E9. Strengths & Limitations of E10. Methods of Rs 11. Benefits , side effect and risks

in Rs12. Evidence Links (Gs of Rs – LoE)13. External Review 14. Update Procedure

DOMAIN 3. RIGOUR OF DEVELOPMENTMethods, literature search strategy & appendices+ inclusion/ exclusion criteria+ Evidence tables, clinical evidence, evidence description (results), evidence interpretation (discussion)Methods, CPG Development process same sections+ Rs, Key Evidence+ acknowledgements+ CPG update, date of CPG

Domain 4

DOMAIN 4. CLARITY OF PRESENTATION

15. Rs are specific Rs & executive summary

16. Options for management + discussion, Treatment (options/alternatives)

17. Recommendation identifiableKey Rs; separate (e.g. QRG)

Domain 5

DOMAIN 5. APPLICABILITY

18. Facilitators & barriers CPG dissemination/ implementation, barriers,

CPG utilization & Quality indicators

19. Tools+ tools, resources, appendices

20. Resource implicationsMethod, cost utility, cost effectiveness,

acquisition costs & implications for budgets

21. Monitoring /audit criteria Rs, Quality indicators & audit criteria

Domain 6

DOMAIN 6. EDITORIAL INDEPENDENCE

22. Funding bodyDisclaimer & funding source

23. Competing interestsMethods, Conflicts of interest (COI),

CPG panel & appendices

Overall Assessment

OVERALL CPG ASSESSMENT 1. Rate the overall quality of this CPG

2. I would recommend this CPG for use

3. Notes

YES Yes ,with modification No

Using the AGREE II Instrument 27

Selected CPG

DomainsOverall

Is CPG Recommended

for use ?1 2 3 4 5 6

CPG 1

CPG 2

CPG 3

CPG 4

CPG 5

Finally AGREE II Domain Scores Colour Coding (Dr. Lubna Alansary)

< 40 % Red >41-70 Yellow >71 Green

AGREE Domains Scores Table

CPG 1: SIGN

CPG 2: EPR3

CPG 3: GINA

CPG 4: ICSI

CPG 5: Singapore MOH

Domain 1 60 % 74 % 45 % 61 % 42 %Domain 2 55 % 56 % 60 % 58 % 63 %Domain 3 92 % 83 % 79 % 38 % 43 %Domain 4 95 % 90 % 92 % 75 % 87 %Domain 5 70 % 82 % 80 % 33 % 58 %Domain 6 80 % 60 % 22 % 50 % 10 %

Graphical Representation

AGREE II rater concordance calculator(McMaster University)

AGREE Enterprise website http://www.agreetrust.org/

My AGREE (soon Our AGREE)

My AGREE II Report PDF

The cycle of development, publication, and implementation of CPGs for CKDJoseph A Vassalotti. Implementation or translation into practice should contribute to the development of a subsequent guideline, primarily through health services research. Clinical decision support is shown as the implementation method that bridges the gap between the evidence synthesized by clinical practice guidelines and patient care delivered through the electronic health record. The three major components of information technology in health care are shown: the personal health record, the electronic health record, and the population health record. The arrows represent the flow of information. The arrow between the patient and the personal health record is mostly in the direction of the patient, as patient input into the electronic health record is currently limited

Acknowledgments

Dr. Yasser Sami Amer

MSc Pediatrics, MSc HC InformaticsEBCPGs Advisor & Trainer

yasser3amer@yahoo.com