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International Journal for Quality in Health Care Advance Access originally published online on March 2, 2005
International Journal for Quality in Health Care 2005 17(3):235-242; doi:10.1093/intqhc/mzi027
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International Journal for Quality in Health Care vol. 17 no. 3 © The Author 2005. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit

Joan Vlayen1,2, Bert Aertgeerts1,3, Karin Hannes1, Walter Sermeus2 and Dirk Ramaekers1,4

1 Belgian Centre for Evidence-Based Medicine, Leuven, Belgium 2 Catholic University Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium 3 Catholic University Leuven, Academic Centre for General Practice, Leuven, Belgium, and 4 Belgian Federal Health Care Knowledge Centre, Brussels, Belgium

Objective. 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.

Design. 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. Content analysis and scoring of these domains by the appraisal tools was 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 instrument is the only validated instrument that uses a numerical 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.

Keywords: appraisal tool, clinical pathways, content analysis, practice guidelines

Address reprint requests to Joan Vlayen, Centre for Health Services and Nursing Research, Kapucijnenvoer 35, B-3000 Leuven, Belgium. E-mail: joan.vlayen{at}med.kuleuven.ac.be

Accepted for publication January 5, 2005.


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