Raising the Quality of Rheumatology Management
Raising the Quality of Rheumatology Management
Objective. To increase understanding of how to raise the quality of rheumatology guidelines by reviewing European League Against Rheumatism (EULAR) management recommendations, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, 10 years after publication of the EULAR standardized operating procedures (SOP) for the production of recommendations. It was hoped that this work could help inform improvements in guideline development by other societies and organizations.
Methods. The SOP were published in 2004 to ensure the quality of EULAR-endorsed recommendations. We reviewed 27 published EULAR recommendations for management using the AGREE II tool. This provides a framework to assess the quality of guidelines across six broad domains using 23 specific questions.
Results. Overall the EULAR recommendations reviewed have been performed to a high standard. There are particular strengths in the methodology and presentation of the guidelines; however, the results indicate areas for development in future recommendations: in particular, stakeholder involvement and applicability of the recommendations. Improvements in quality were evident in recent years, with patient representation in 9 of 15 (60.0%) recommendations published 2010–14 compared with 4 of 12 (33.3%) published 2000–09.
Conclusion. In the last 10 years the overall quality of recommendations was good, with standards improving over the decade following publication of the SOP. However, this review process has identified potential areas for improvement, especially in patient representation and provision of implementation tools. The lessons from this work can be applied to the development of rheumatology guidelines by other societies and organizations.
Ensuring the quality of rheumatology management guidelines by using robust and reliable methodology is vital in maintaining the confidence of clinicians. The European League Against Rheumatism (EULAR) executive committee published their standardized operating procedures (SOP) for the elaboration, evaluation, dissemination and implementation of recommendations in 2004 to provide a formal structure for ensuring the quality of EULAR-endorsed recommendations. The SOP describes in detail methodological aspects for consideration when producing recommendations, including a clear statement of the objectives, target population and appropriate steering group members, and use of a vigorous evidence-based approach to review and assess the quality of the literature, including a description of categories of evidence and strength of the recommendations. It also describes the subsequent presentation of the recommendations, assessment of their relevance, and the process for dissemination, implementation and updating of such recommendations.
A decade after the publication of the SOP for the production of recommendations, we assessed the quality of existing EULAR management recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. The original AGREE instrument was published in 2003 by a group of international guideline developers and researchers, the AGREE collaboration, to provide a standardized structure for guidelines in development in order to improve consistency in quality, and provide a framework for assessing the quality of published guidelines. The AGREE instrument was updated on its 10th anniversary in 2013, funded by a grant from the Canadian Institute of Health Research, and includes six quality domains using 23 specific questions. The domains cover the scope and purpose; the extent of stakeholder involvement; rigour of the methodology and development process; clarity of presentation of the guideline; consideration of applicability, including barriers to and facilitators of guideline implementation and resource implications; and editorial independence. We were interested to learn lessons from this review that would be useful in raising the standards of rheumatology guidelines developed by other international societies and organizations.
Abstract and Introduction
Abstract
Objective. To increase understanding of how to raise the quality of rheumatology guidelines by reviewing European League Against Rheumatism (EULAR) management recommendations, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, 10 years after publication of the EULAR standardized operating procedures (SOP) for the production of recommendations. It was hoped that this work could help inform improvements in guideline development by other societies and organizations.
Methods. The SOP were published in 2004 to ensure the quality of EULAR-endorsed recommendations. We reviewed 27 published EULAR recommendations for management using the AGREE II tool. This provides a framework to assess the quality of guidelines across six broad domains using 23 specific questions.
Results. Overall the EULAR recommendations reviewed have been performed to a high standard. There are particular strengths in the methodology and presentation of the guidelines; however, the results indicate areas for development in future recommendations: in particular, stakeholder involvement and applicability of the recommendations. Improvements in quality were evident in recent years, with patient representation in 9 of 15 (60.0%) recommendations published 2010–14 compared with 4 of 12 (33.3%) published 2000–09.
Conclusion. In the last 10 years the overall quality of recommendations was good, with standards improving over the decade following publication of the SOP. However, this review process has identified potential areas for improvement, especially in patient representation and provision of implementation tools. The lessons from this work can be applied to the development of rheumatology guidelines by other societies and organizations.
Introduction
Ensuring the quality of rheumatology management guidelines by using robust and reliable methodology is vital in maintaining the confidence of clinicians. The European League Against Rheumatism (EULAR) executive committee published their standardized operating procedures (SOP) for the elaboration, evaluation, dissemination and implementation of recommendations in 2004 to provide a formal structure for ensuring the quality of EULAR-endorsed recommendations. The SOP describes in detail methodological aspects for consideration when producing recommendations, including a clear statement of the objectives, target population and appropriate steering group members, and use of a vigorous evidence-based approach to review and assess the quality of the literature, including a description of categories of evidence and strength of the recommendations. It also describes the subsequent presentation of the recommendations, assessment of their relevance, and the process for dissemination, implementation and updating of such recommendations.
A decade after the publication of the SOP for the production of recommendations, we assessed the quality of existing EULAR management recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. The original AGREE instrument was published in 2003 by a group of international guideline developers and researchers, the AGREE collaboration, to provide a standardized structure for guidelines in development in order to improve consistency in quality, and provide a framework for assessing the quality of published guidelines. The AGREE instrument was updated on its 10th anniversary in 2013, funded by a grant from the Canadian Institute of Health Research, and includes six quality domains using 23 specific questions. The domains cover the scope and purpose; the extent of stakeholder involvement; rigour of the methodology and development process; clarity of presentation of the guideline; consideration of applicability, including barriers to and facilitators of guideline implementation and resource implications; and editorial independence. We were interested to learn lessons from this review that would be useful in raising the standards of rheumatology guidelines developed by other international societies and organizations.