Appraising a tool for guideline appraisal (the AGREE II instrument).

The AGREE II instrument has 3 goals e to assess the quality of clinical practice guidelines (CPGs), to provide a methodologic strategy for the development of guidelines, and to recommend how and what information should be reported in guidelines. Of these, the main purpose seems to be to assess guideline quality (i.e., ‘‘confidence that the potential biases of guideline development have been addressed adequately and that the recommendations are both internally and externally valid, and are feasible for practice’’) [1]. There is no doubt that this instrument is badly needed by health care providers and policy-makers around the world, who deal with a deluge of clinical practice guidelines in their day-to-day decisions. AGREE II assesses CPGs based on 6 domains: 1) scope and purpose, 2) stakeholder involvement, 3) rigor of development, 4) clarity and presentation, 5) applicability, and 6) editorial independence. Each domain is scored using several items. There are a total of 23 items in all to be scored on a 7-point Likert scale by at least 2 (preferably 4) independent observers. This is not a run of the mill appraisal guide, as users may take an average of 90 minutes to complete an evaluation. To learn more about the instrument, we decided to use it to evaluate Philippine Guidelines on Periodic Health Examinations [2]. Because we were personally involved in drafting these guidelines, the process took only 53 minutes. Below, we reflect on our experience in using AGREE II: