To Agree and To be Agreed: A Brief Introduction to the AGREE Tools

What are the AGREE tools?

As researchers and physicians in clinical practices, we may wonder if we can follow an existing guideline in a specific healthcare setting. We may also wonder if we can propose a new practice guideline and have it accepted by others in our field. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) tools were created precisely to help evaluate, develop, and report a high-quality clinical guideline.

Why use the AGREE tools?

The AGREE framework has been used since 2003 and provides quantitative appraisal tools to assess guidelines in public health, disease prevention, screening, diagnosis, and management. They have been used by health care providers and policy makers and cited in thousands of publications worldwide. Moreover, application of the AGREE instrument has been recommended by healthcare organizations such as the World Health Organization, the British National Institute for Health and Care Excellence, and the Association of Scientific Medical Societies in Germany.

Ultimately, the reliability and trustworthiness of a clinical practice guideline depends on its high quality. To that end, the AGREE tools provide a framework to help to assess the methodological rigor and transparency of a clinical practice guideline, which in turn, allows users to determine whether a guideline is suitable for its intended use.

What is included within AGREE?

The AGREE II instrument includes 23 items in 6 domains and 2 overall assessments. While the AGREE II instrument outlines the detailed criteria to assess, develop, and report a practice guideline, integrated tools have more specific applications. For example, the AGREE Reporting Checklist is designed to ensure the completeness and transparency specifically for reporting practice guidelines. Another tool, AGREE-S, assists the development of guidelines related to surgical interventions. Whether you need to assess the methodological rigor of a practice guidelines, the checklist to assess completeness of reporting, or conduct appraisals, all AGREE tools are free to download at the AGREE website.

How to use the AGREE tools?

A user can rate each item on a scale of 1 to 7 that is used to calculate a quality score for each domain. Based on how the domain score compares with a threshold score, a user can identify the strengths and limitations of the guideline. In the end, the user determines the overall quality of the guideline and whether the guideline can be used in a specific clinical circumstance. The reporter of a practice guideline can use this checklist to draft and finalize a guideline as well as perform a quality inspection. Importantly, the AGREE website provides a free training and exercise on how to use the AGREE tools.

Medical reporting guidelines are essential for conducting research in a clinical setting and reporting findings. The AGREE tools can help make sure you use or develop the most appropriate one.