Navigating clinical decision making: panorama analysis of clinical practice guideline evaluation tools_Chinese Journal of Evidence-Based Medicine

Authors：

XU Caihua ¹ , ZHOU Yongjia ² , LI Yiyi ² , CUI Yating ¹ , TANG Xiao ³ ,  TIAN Jinhui ¹ ,  ZHANG Junhua ⁴

1. Center for Evidence-based Medicine, School of Basic Medicine, Lanzhou University, Lanzhou 730000, P. R. China;
2. School of Nursing, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, P. R. China;
3. The First Clinical Medical College, Lanzhou University, Lanzhou 730000, P. R. China;
4. Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China;

Corresponding author：

TIAN Jinhui, Email: tjh996@163.com; ZHANG Junhua, Email: zjhtcm@foxmail.com

Keywords：

Clinical practice guidelines; Evidence-based medicine; Quality assessment

DOI：

10.7507/1672-2531.202409003

Video：

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Abstract Full text Figures/Tables Video References Cited by

Clinical practice guidelines (CPGs) serve as the cornerstone of medical decision-making, with evaluation tools such as AGREE and RIGHT designed to ensure that these guidelines are grounded in the best available evidence and contribute to enhancing healthcare quality. This article reviews the historical development and current status of CPG evaluation tools, examining their diversity, complexity, application challenges, and inconsistencies in evaluation outcomes. A thorough discussion is provided on the strengths and weaknesses of existing evaluation tools, along with proposed future developmental directions. It is recommended that future efforts prioritize the creation of more streamlined tool designs, foster enhanced international collaboration strategies, and incorporate artificial intelligence technologies. These initiatives aim to improve both the efficiency and accuracy of evaluative processes while facilitating advancements in healthcare practices towards elevated quality standards.

1.	张悦, 张士靖, 周志超, 等. 国际临床指南评价工具的发展与启示. 中华医学图书情报杂志 2015, 24(1): 11-16.
2.	王丽颖, 刘孟宇, 王跃溪, 等. 我国临床诊疗指南评价现状述评. 中华中医药杂志, 2016, 31(4): 1316-1319.
3.	Kim SY. Recent advance in clinical practice guideline development methodology. Korean J Fam Med, 2022, 43(6): 347-352.
4.	Qumseya B, Goddard A, Qumseya A, et al. Barriers to clinical practice guideline implementation among physicians: a physician survey. Int J Gen Med, 2021, 14: 7591-7598.
5.	Lima JP, Mirza RD, Guyatt GH. How to recognize a trustworthy clinical practice guideline. J Anesth Analg Crit Care, 2023, 3(1): 9.
6.	Vlayen J, Aertgeerts B, Hannes K, et al. A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit. Int J Qual Health Care, 2005, 17(3): 235-242.
7.	Graham ID, Calder LA, Hébert PC, et al. A comparison of clinical practice guideline appraisal instruments. Int J Technol Assess Health Care, 2000, 16(4): 1024-1038.
8.	孙雅佳, 史乾灵, 杨楠, 等. 临床实践指南综合评价的思考与探索. 协和医学杂志, 2023, 14(1): 22-30.
9.	AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the agree project. Qual Saf Health Care, 2003, 12(1): 18-23.
10.	Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
11.	倪明, 王琳辉, 李广涛, 等. 基于AGREE-China对中文乳腺癌诊治相关指南/共识的质量评估. 中国肿瘤, 2022, 31(10): 828-838.
12.	Chen YL, Yang KH, Marušić A, et al. A reporting tool for practice guidelines in healthcare: the right statement. Ann Intern Med, 2017, 166: 128-132.
13.	刁莎, 李思雨, 石雨晴, 等. 指南临床适用性评价工具(2. 0版)解读. 中国循证医学杂志, 2023, 23(11): 1318-1322.
14.	靳英辉, 赵志慧, 黄粲然, 等. 临床实践指南实施性评价工具的研制和验证评价. 中国循证医学杂志, 2022, 22(1): 111-119.
15.	Yang N, Liu H, Zhao W, et al. Development of the scientific, transparent and applicable rankings (star) tool for clinical practice guidelines. Chin Med J, 2023, 136(12): 1430-1438.
16.	Siering U, Eikermann M, Hausner E, et al. Appraisal tools for clinical practice guidelines: a systematic review. PLoS One, 2013, 8(12): e82915.
17.	Brouwers MC, Kho ME, Browman GP, et al. Development of the AGREE II, part 1: performance, usefulness and areas for improvement. CMAJ, 2010, 182(10): 1045-52.
18.	Brouwers MC, Spithoff K, Kerkvliet K, et al. Development and validation of a tool to assess the quality of clinical practice guideline recommendations. JAMA Netw Open, 2020, 3(5): e205535.
19.	Brouwers MC, Lavis JN, Spithoff K, et al. Assessment of health systems guidance using the appraisal of guidelines for research and evaluation - health systems (agree-hs) instrument. Health Policy, 2019, 123(7): 646-651.
20.	Antoniou SA, Florez ID, Markar S, et al. AGREE-S: AGREE II extension for surgical interventions: appraisal instrument. Surg Endosc, 2022, 36(8): 5547-5558.
21.	Brouwers MC, Kho ME, Browman GP, et al. The global rating scale complements the AGREE II in advancing the quality of practice guidelines. J Clin Epidemiol, 2012, 65(5): 526-534.
22.	王吉耀, 王强, 王小钦, 等. 中国临床实践指南评价体系的制定与初步验证. 上海医学, 2018, 41(6): 321-326.
23.	Zhou Q, Xing D, Li Q, et al. An extension of the RIGHT statement for introductions and interpretations of clinical practice guidelines: right for int. J Evid Based Med, 2022, 15(1): 55-63.
24.	Tang C, Duan Y, Zhang Y, et al. RIGHT for acupuncture: an extension of the right statement for clinical practice guidelines on acupuncture. J Clin Epidemiol, 2021, 139: 330-339.
25.	Xie R, Xia Y, Chen Y, et al. The RIGHT extension statement for traditional Chinese medicine: development, recommendations, and explanation. Pharmacol Res, 2020, 160: 105178.
26.	Wang X, Chen Y, Akl EA, et al. The reporting checklist for public versions of guidelines: RIGHT-PVG. Implement Sci, 2021, 16: 10.
27.	Song Y, Alonso-Coello P, Ballesteros M, et al. A reporting tool for adapted guidelines in health care: the RIGHT-Ad@pt checklist. Ann Intern Med, 2022, 175(5): 710-719.
28.	Li X, Huang L, Wang L, et al. the reporting checklist for Chinese patent medicine guidelines: RIGHT FOR CPM. Pharmacol Res, 2024, 199: 107015.
29.	Vernooij RWM, Alonso-Coello P, Brouwers M, et al. Reporting items for updated clinical guidelines: checklist for the reporting of updated guidelines (CheckUp). PLoS Med, 2017, 14(1): e1002207.
30.	Shiffman RN, Shekelle P, Overhage JM, et al. Standardized reporting of clinical practice guidelines: a proposal from the conference on guideline standardization. Ann Intern Med, 2003, 139: 493-498.
31.	靳英辉, 赵志慧, 黄粲然, 等. 临床实践指南实施性评价工具的研制和验证评价. 中国循证医学杂志, 2022, 22(1): 111-119.

1. 张悦, 张士靖, 周志超, 等. 国际临床指南评价工具的发展与启示. 中华医学图书情报杂志 2015, 24(1): 11-16.
2. 王丽颖, 刘孟宇, 王跃溪, 等. 我国临床诊疗指南评价现状述评. 中华中医药杂志, 2016, 31(4): 1316-1319.
3. Kim SY. Recent advance in clinical practice guideline development methodology. Korean J Fam Med, 2022, 43(6): 347-352.
4. Qumseya B, Goddard A, Qumseya A, et al. Barriers to clinical practice guideline implementation among physicians: a physician survey. Int J Gen Med, 2021, 14: 7591-7598.
5. Lima JP, Mirza RD, Guyatt GH. How to recognize a trustworthy clinical practice guideline. J Anesth Analg Crit Care, 2023, 3(1): 9.
6. Vlayen J, Aertgeerts B, Hannes K, et al. A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit. Int J Qual Health Care, 2005, 17(3): 235-242.
7. Graham ID, Calder LA, Hébert PC, et al. A comparison of clinical practice guideline appraisal instruments. Int J Technol Assess Health Care, 2000, 16(4): 1024-1038.
8. 孙雅佳, 史乾灵, 杨楠, 等. 临床实践指南综合评价的思考与探索. 协和医学杂志, 2023, 14(1): 22-30.
9. AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the agree project. Qual Saf Health Care, 2003, 12(1): 18-23.
10. Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
11. 倪明, 王琳辉, 李广涛, 等. 基于AGREE-China对中文乳腺癌诊治相关指南/共识的质量评估. 中国肿瘤, 2022, 31(10): 828-838.
12. Chen YL, Yang KH, Marušić A, et al. A reporting tool for practice guidelines in healthcare: the right statement. Ann Intern Med, 2017, 166: 128-132.
13. 刁莎, 李思雨, 石雨晴, 等. 指南临床适用性评价工具(2. 0版)解读. 中国循证医学杂志, 2023, 23(11): 1318-1322.
14. 靳英辉, 赵志慧, 黄粲然, 等. 临床实践指南实施性评价工具的研制和验证评价. 中国循证医学杂志, 2022, 22(1): 111-119.
15. Yang N, Liu H, Zhao W, et al. Development of the scientific, transparent and applicable rankings (star) tool for clinical practice guidelines. Chin Med J, 2023, 136(12): 1430-1438.
16. Siering U, Eikermann M, Hausner E, et al. Appraisal tools for clinical practice guidelines: a systematic review. PLoS One, 2013, 8(12): e82915.
17. Brouwers MC, Kho ME, Browman GP, et al. Development of the AGREE II, part 1: performance, usefulness and areas for improvement. CMAJ, 2010, 182(10): 1045-52.
18. Brouwers MC, Spithoff K, Kerkvliet K, et al. Development and validation of a tool to assess the quality of clinical practice guideline recommendations. JAMA Netw Open, 2020, 3(5): e205535.
19. Brouwers MC, Lavis JN, Spithoff K, et al. Assessment of health systems guidance using the appraisal of guidelines for research and evaluation - health systems (agree-hs) instrument. Health Policy, 2019, 123(7): 646-651.
20. Antoniou SA, Florez ID, Markar S, et al. AGREE-S: AGREE II extension for surgical interventions: appraisal instrument. Surg Endosc, 2022, 36(8): 5547-5558.
21. Brouwers MC, Kho ME, Browman GP, et al. The global rating scale complements the AGREE II in advancing the quality of practice guidelines. J Clin Epidemiol, 2012, 65(5): 526-534.
22. 王吉耀, 王强, 王小钦, 等. 中国临床实践指南评价体系的制定与初步验证. 上海医学, 2018, 41(6): 321-326.
23. Zhou Q, Xing D, Li Q, et al. An extension of the RIGHT statement for introductions and interpretations of clinical practice guidelines: right for int. J Evid Based Med, 2022, 15(1): 55-63.
24. Tang C, Duan Y, Zhang Y, et al. RIGHT for acupuncture: an extension of the right statement for clinical practice guidelines on acupuncture. J Clin Epidemiol, 2021, 139: 330-339.
25. Xie R, Xia Y, Chen Y, et al. The RIGHT extension statement for traditional Chinese medicine: development, recommendations, and explanation. Pharmacol Res, 2020, 160: 105178.
26. Wang X, Chen Y, Akl EA, et al. The reporting checklist for public versions of guidelines: RIGHT-PVG. Implement Sci, 2021, 16: 10.
27. Song Y, Alonso-Coello P, Ballesteros M, et al. A reporting tool for adapted guidelines in health care: the RIGHT-Ad@pt checklist. Ann Intern Med, 2022, 175(5): 710-719.
28. Li X, Huang L, Wang L, et al. the reporting checklist for Chinese patent medicine guidelines: RIGHT FOR CPM. Pharmacol Res, 2024, 199: 107015.
29. Vernooij RWM, Alonso-Coello P, Brouwers M, et al. Reporting items for updated clinical guidelines: checklist for the reporting of updated guidelines (CheckUp). PLoS Med, 2017, 14(1): e1002207.
30. Shiffman RN, Shekelle P, Overhage JM, et al. Standardized reporting of clinical practice guidelines: a proposal from the conference on guideline standardization. Ann Intern Med, 2003, 139: 493-498.
31. 靳英辉, 赵志慧, 黄粲然, 等. 临床实践指南实施性评价工具的研制和验证评价. 中国循证医学杂志, 2022, 22(1): 111-119.

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