CHARACTERISTICS OF HIGH-QUALITY GUIDELINES

Objectives: To identify predictors of high-quality clinical practice guidelines. Methods: A total of 86 guidelines from 11 countries were assessed by four independent appraisers per guideline using the AGREE instrument (23 items). Six aspects of guideline development were considered to explain the variation in quality scores: care level (primary/secondary care), scope (diagnosis/treatment), type of guideline (new/update), year of publication, type of agency (governmental/professional), and whether the guideline was produced within a structured and coordinated program. Results: Guidelines produced within a guideline program and by governmental agencies had higher scores than their counterparts. Differences in the applicability of the guidelines could not be explained by the variables studied. Conclusions: To ensure high quality, clinical guidelines should be produced within a structured and coordinated program. Professional organizations or specialist societies that aim to develop guidelines may adopt quality criteria from leading guideline agencies.

[1]  Nigel Rice,et al.  Multilevel Models: Applications to Health Data , 1996, Journal of health services research & policy.

[2]  R. Grol,et al.  Guideline development in Europe. An international comparison , 2000 .

[3]  M. Mayo-Smith,et al.  Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. , 1999, JAMA.

[4]  M. Field,et al.  A Provisional Instrument for Assessing Clinical Practice Guidelines , 1992 .

[5]  J. Grimshaw,et al.  Potential benefits, limitations, and harms of clinical guidelines , 1999, BMJ.

[6]  J. Ward,et al.  Why we need guidelines for guidelines: a study of the quality of clinical practice guidelines in Australia , 1996, The Medical journal of Australia.

[7]  G. Browman,et al.  IMPROVING CLINICAL PRACTICE GUIDELINES FOR THE 21ST CENTURY , 2000, International Journal of Technology Assessment in Health Care.

[8]  V. Carey,et al.  Mixed-Effects Models in S and S-Plus , 2001 .

[9]  Siep Thomas,et al.  Attributes of clinical guidelines that influence use of guidelines in general practice: observational study , 1998, BMJ.

[10]  M. Mäkelä,et al.  Practice guidelines in Finland: availability and quality. , 1997, Quality in health care : QHC.

[11]  I D Graham,et al.  A COMPARISON OF CLINICAL PRACTICE GUIDELINE APPRAISAL INSTRUMENTS , 2000, International Journal of Technology Assessment in Health Care.

[12]  J. Grimshaw,et al.  Development and application of a generic methodology to assess the quality of clinical guidelines. , 1999, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[13]  Alessandro Liberati,et al.  Practice guidelines developed by specialty societies: the need for a critical appraisal , 2000, The Lancet.

[14]  R. Thomson,et al.  Fortnightly Review: How to ensure that guidelines are effective , 1995 .

[15]  M. Field,et al.  Clinical practice guidelines : directions for a new program , 1990 .