Improving the reliability of clinical practice guideline appraisals: effects of the Korean AGREE II scoring guide

Abstract

The Korean translated Appraisal of Guidelines for Research and Evaluation II (Korean AGREE II) instrument was distributed into Korean medical societies in 2011. However, inter-rater disagreement issues still exist. The Korean AGREE II scoring guide was therefore developed to reduce inter-rater differences. This study examines the effects of the Korean AGREE II scoring guide to reduce inter-rater differences. Appraisers were randomly assigned to two groups (Scoring Guide group and Non-Scoring Guide group). The Korean AGREE II instrument was provided to both groups. However, the scoring guide was offered to Scoring Guide group only. Total 14 appraisers were participated and each guideline was assessed by 8 appraisers. To evaluate the reliability of the Korean AGREE II scoring guide, correlation of scores among appraisers and domain-specific intra-class correlation (ICC) were compared. Most scores of two groups were comparable. Scoring Guide group showed higher reliability at all guidelines. They showed higher correlation among appraisers and higher ICC values at almost all domains. The scoring guide reduces the inter-rater disagreement and improves the overall reliability of the Korean-AGREE II instrument.

Keywords: Clinical Practice Guideline; Observer Variation; Reproducibility of Results.

Fig. 1

Distribution of Korean AGREE II domain scores according to the use of Scoring Guide for Cancer pain management guideline (A) and GERD guideline (B). Black boxs are Scoring guide group and white boxs are Non-Scoring Guide group. The top and bottom of the box indicates the 75th (Q3) and 25th percentile (Q1), respectively, and the horizontal line in the box means the 50th percentile (the median). The upper and lower ends of the whisker represent Q3+1.5×(interquartile range), and Q1-1.5×(interquartile range), respectively.