Article type
Year
Abstract
Background: One way to implement clinical practice guidelines into daily practice are clinical pathways. Unlike clinical practice guidelines, no (validated) instrument exists to assess the methodological quality of clinical pathways. A possible strategy to develop a critical appraisal tool for clinical pathways is to base it on an appraisal tool for clinical practice guidelines.
Objectives: To identify a critical appraisal tool for clinical practice guidelines that could serve as a basis for the development of an appraisal tool for clinical pathways.
Methods: A systematic review of the literature and personal contacts. Databases searched were: MEDLINE, EMBASE and CINAHL. Search terms were: practice guidelines, appraisal and evaluation. The items of the identified appraisal tools were examined and thematically grouped into 10 guideline dimensions (validity, reliability/reproducibility, clinical applicability, clinical flexibility, multidisciplinary process, clarity, scheduled review, dissemination, implementation and evaluation). Content analysis and scoring of these domains by the appraisal tools were evaluated.
Results: Twenty-four different appraisal tools of practice guidelines were identified. None scored the evidence-base of the clinical content of guidelines. Four tools scored all the guideline dimensions. The Cluzeau instrument is the only one of these four that has been validated. Of the three instruments based on the Cluzeau instrument, the AGREE (Appraisal of Guidelines for Research and Education) instrument is the only validated instrument that uses a numeric scale.
Conclusions: Being a simplified version of the Cluzeau instrument, the AGREE instrument has the most potential to serve as a basis for the development of an appraisal tool for clinical pathways. However, important limitations will have to be dealt with when developing such a tool.
Objectives: To identify a critical appraisal tool for clinical practice guidelines that could serve as a basis for the development of an appraisal tool for clinical pathways.
Methods: A systematic review of the literature and personal contacts. Databases searched were: MEDLINE, EMBASE and CINAHL. Search terms were: practice guidelines, appraisal and evaluation. The items of the identified appraisal tools were examined and thematically grouped into 10 guideline dimensions (validity, reliability/reproducibility, clinical applicability, clinical flexibility, multidisciplinary process, clarity, scheduled review, dissemination, implementation and evaluation). Content analysis and scoring of these domains by the appraisal tools were evaluated.
Results: Twenty-four different appraisal tools of practice guidelines were identified. None scored the evidence-base of the clinical content of guidelines. Four tools scored all the guideline dimensions. The Cluzeau instrument is the only one of these four that has been validated. Of the three instruments based on the Cluzeau instrument, the AGREE (Appraisal of Guidelines for Research and Education) instrument is the only validated instrument that uses a numeric scale.
Conclusions: Being a simplified version of the Cluzeau instrument, the AGREE instrument has the most potential to serve as a basis for the development of an appraisal tool for clinical pathways. However, important limitations will have to be dealt with when developing such a tool.