Purpose of the AGREE instrument

The purpose of the Appraisal of Guidelines Research & Evaluation (AGREE) Instrument is to provide a
framework for assessing the quality of clinical practice guidelines.
Clinical practice guidelines are ‘systematically developed statements to assist practitioner and patient
decisions about appropriate health care for specific clinical circumstances’(1). Their purpose is ‘to make explicit
recommendations with a definite intent to influence what clinicians do’(2).
By quality of clinical practice guidelines we mean the 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. This process involves taking into account the benefits, harms
and costs of the recommendations, as well as the practical issues attached to them. Therefore, the
assessment includes judgements about the methods used for developing the guidelines, the content of the
final recommendations, and the factors linked to their uptake.
The AGREE Instrument assesses both the quality of the reporting, and the quality of some aspects of
recommendations. It provides an assessment of the predicted validity of a guideline, that is the likelihood
that it will achieve its intended outcome. It does not assess the impact of a guideline on patients’ outcomes.
Most of the criteria contained in the AGREE Instrument are based on theoretical assumptions rather than on
empirical evidence. They have been developed through discussions between researchers from several
countries who have extensive experience and knowledge of clinical guidelines. Thus, the AGREE Instrument
should be perceived as reflecting the current state of knowledge in the field.

The AGREE Instrument is designed to assess guidelines developed by local, regional, national or international
groups or affiliated governmental organisations. These include:
1. New guidelines
2. Existing guidelines
3. Updates of existing guidelines
The AGREE Instrument is generic and can be applied to guidelines in any disease area including those for
diagnosis, health promotion, treatment or interventions. It is suitable for guidelines presented in paper or
electronic format.

(1) Lohr KN, Field MJ. A provisional instrument for assessing clinical practice guidelines. In: Field MJ, Lohr KN (eds).
Guidelines for clinical practice. From development to use. Washington D.C. National Academy Press, 1992.
(2 Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt G, for the Evidence-Based Medicine Working Group.
Users’ guides to the Medical Literature. VIII. How to Use Clinical Practice Guidelines. A. Are the
Recommendations Valid? JAMA, 1995;274, 570-574.