Dual uses of AGREE II: a tool for guideline evaluation and development

Article type
Authors
Morgan RL1, Lwin TZ2
1Centers for Disease Control and Prevention, USA
2Fullbright Fellow, Myanmar
Abstract
Background: In 1998, the United States Centers for Disease Control and Prevention (CDC) produced Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease. Since that time, additional research has been published on screening and care for HCV infection necessitating an update to these recommendations.

Objectives: The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument can be applied to assess the quality of published guidelines, as well as direct the development process. The objective of this work was to evaluate the 1998 recommendations using the AGREE II instrument.

Methods: Two reviewers independently rated the 1998 recommendations based on the AGREE II instrument. The instrument is a six domain, 23-item, Likert scale ranging from strongly disagree (1) to strongly agree (7). The quality of the recommendations was scored for each domain: scope and purpose; stakeholder involvement; rigor of development; clarity of presentation; applicability; and editorial independence from competing interests.

Results: Of the six domains, scores varied from 86% to 0%. The clarity of presentation (86%) and stakeholder involvement (67%) were more clearly presented in the 1998 recommendations than the scope and purpose (43%), applicability (29%), rigor of development (16%), and editorial independence (0%). Editorial independence was lowest as items regarding funding bodies and conflicts of interest were not clearly addressed. Inter-rater reliability with the AGREE II instrument between the two reviewers was 0.82.

Conclusions: Evaluation of the 1998 recommendations according to the AGREE II instrument highlights well developed domains to maintain and weaker domains to strengthen for the update of these recommendations. Using the AGREE II instrument to develop the updated HCV infection recommendations will allow for improvements to be made to the scope and purpose, applicability, rigor of development, and editorial independence, increasing the quality of the document.