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AGREE II Instrument training

The gold standard for appraisal of clinical practice guidelines (CPGs): The AGREE II Instrument.<br>Official website: https://www.agreetrust.org/<br>

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AGREE II Instrument training

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  1. InstructorDr. Yasser Sami AmerMS Pediatrics, MS Healthcare Informatics, CPHQCoordinator, CPG Steering Committee and Quality Management King Khalid University Hospital, King Saud UniversityMember, G-I-N Adaptation & Implementation Working GroupsCPG Advisor , King Saud University and Alexandria University Hospitals

  2. Purpose To guide on how to use and apply the AGREE II for assessing CPGS • Items • Domains • User’s Manual • Website

  3. 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. • The AGREE Enterprise Website

  4. What is the AGREE II Tool ? History 1stAGREE was published in 2003,then refined in 2009 AGREE II (New scoring “7 point scale” – Items modifications – New user’s manual) – 11 YEARS ! Assess • Quality (Methodological rigor & transparency; confident in resulting Recommendations) Can be applied to any CPG in any Disease area ! Guide • CPGs Development • CPGs Reporting Using the AGREE II Instrument

  5. Who can use the AGREE II ? • Healthcare providers/ clinicians • CPG developers/ adapters • Policy makers • Educators

  6. Considerations before a CPG Assessment

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

  8. The AGREE II Includes….

  9. 23 Items in 6 DomainsUSER’S MANUAL page 7

  10. Items and Domains: A Closer Look AGREE 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:

  11. Domain 1

  12. DOMAIN 1. SCOPE AND PURPOSE 1. Objective(s): • Health impact & benefits of a CPG on target population • Introduction, scope, purpose, rationale, background & objectives

  13. Examples of CPG Objective(s)

  14. SIGN Asthma CPG 2012

  15. DOMAIN 1. SCOPE AND PURPOSE Health Question(s):- Questions, Scope, Purpose, Rationale and Background 3. Target population:- Pt. population, target population, relevant pt.s, scope and purpose

  16. Health/ Clinical/ Key Questions Patient(& disease characteristics) Intervention(s) Professionals(Target users) Outcomes(purpose of the CPGs) Healthcare settings (& context) CPG Scope: PIPOH Model EBCPGs: Dr. Yasser Sami Amer

  17. Health/ clinical Questions (PIPOH) Sample Antimicrobial Prophylaxis in Surgery P: Patient/target population: Pediatric (age 1–18 years) and Adult (age 19 years or older) patients planned for undergoing surgical procedures. Note: These CPGs do not specifically address newborn (premature and full-term) infants. While the CPGs do not address all concerns for patients with renal or hepatic dysfunction, antimicrobial prophylaxis often does not need to be modified for these patients when given as a single preoperative dose before surgical incision. I: Intervention and practices considered and CPG Category: Assessment of Therapeutic Effectiveness and Prevention Primary antimicrobial prophylaxis (i.e., prevention of an initial infection) for surgical procedures, including antibiotic choice, dose, and dosage regimen.

  18. P: Professionals and Intended Users (target users/ stakeholders) and Clinical Specialty:Physicians, Nurses, Allied Health Personnel and Clinical Pharmacists in the departments of Surgery and all Surgical subspecialties (Colon and Rectal Surgery, Gastroenterology, Plastic Surgery, Urology, Thoracic Surgery, Vascular Surgery and Neurological Surgery), Obstetrics and Gynecology, Orthopedic Surgery, Ophthalmology and Pharmacology.

  19. O: Major Outcomes Considered • Postoperative infection rates • Postoperative morbidity and mortality rates • Duration and cost of health care • Adverse effects H: Healthcare settings King Saud University Hospitals (KKUH/ KAUH) – Tertiary/ Governmental/ University Hospital – Departments and clinics (mentioned in the clinical specialty)

  20. SIGN Asthma CPG 2012 supporting material

  21. Domain 2

  22. DOMAIN 2. STAKEHOLDER INVOLVEMENT 4. Guideline group Methods, guideline panel list, acknowledgements, & appendices 5. Patient preference Scope, methods, guideline panel list, external review &target population perspectives 6. Target users Target user & intended user

  23. Domain 3

  24. DOMAIN 3. RIGOUR OF DEVELOPMENT • Methods, 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 7. Systematic methods for E search 8. Selection Criteria of E 9. Strengths & Limitations of E 10. Methods of Rs 11. Benefits , side effect and risks in Rs 12. Evidence Links (Gs of Rs – LoE) 13. External Review 14. Update Procedure

  25. Methodology of development • In same CPG document (in brief or detailed) • In a separate document or supplement (usu. Detailed) • Not documented

  26. Within CPG document (ENT IDSA ABRS CPG)

  27. Mentioned but not documented

  28. KSUMC CPGs: Adaptation Process Methodology

  29. Separate Methodology document (SIGN 50: A guideline developer’s handbook -2011)

  30. NICE: The guideline manual (2012)

  31. Domain 4

  32. DOMAIN 4. CLARITY OF PRESENTATION 15. Rs are specific Rs & executive summary 16. Options for management + discussion, Treatment (options/alternatives) 17. Recommendation identifiable Key Rs; separate (e.g. QRG)

  33. Domain 5

  34. DOMAIN 5. APPLICABILITY 18. Facilitators & barriers CPG dissemination/ implementation, barriers, CPG utilization & Quality indicators 19. Tools + tools, resources, appendices 20. Resource implications Method, cost utility, cost effectiveness, acquisition costs & implications for budgets 21. Monitoring /audit criteria Rs, Quality indicators & audit criteria

  35. Domain 6

  36. DOMAIN 6. EDITORIAL INDEPENDENCE 22. Funding body Disclaimer & funding source 23. Competing interests Methods, Conflicts of interest (COI), CPG panel & appendices

  37. Overall Assessment

  38. OVERALL CPG ASSESSMENT • Rate the overall quality of this CPG 2. I would recommend this CPG for use 3. Notes

  39. Graphical Representation

  40. The paper tool (handout!)

  41. Using the AGREE II Instrument

  42. AGREE II rater concordance calculator (EXCEL)

  43. AGREE II rater concordance calculator(McMaster University)

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