临床实践指南质量评价工具AGREE介绍

肝脏 ›› 2026, Vol. 31 ›› Issue (6): 763-767.

临床实践指南质量评价工具AGREE介绍

陈诗卉, 王吉耀, Ivan D.Florez, 夏君

315010 宁波宁波大学附属第一医院病案统计室(陈诗卉);
200032 上海复旦大学附属中山医院(王吉耀);
Department of Pediatrics, University of Antioquia, Medellín,Colombia(Ivan D.Florez);
315100 宁波宁波诺丁汉大学GRADE中心(夏君)

收稿日期:2026-06-01 出版日期:2026-06-30 发布日期:2026-07-29
通讯作者: 夏君,Email:Jun.Xia@nottingham.edu.cn

Received:2026-06-01 Online:2026-06-30 Published:2026-07-29

摘要/Abstract

摘要： 临床实践指南是循证证据转化为临床决策的核心桥梁,其质量直接影响患者的诊疗结局。然而,全球范围内低质量指南大量存在,亟待出现具有规范系统性的质量评价工具。指南研究与评价工具(Appraisal of Guidelines for Research & Evaluation Instrument, AGREE)自2003年问世以来,已成为涵盖多个工具的完整评价体系,被国际指南领域公认为“金标准”。2026年5月,中国临床实践指南联盟(GUIDANCE)于上海召开闭门学术会议,特别邀请AGREE工作组主席、哥伦比亚安蒂奥基亚大学Ivan D. Florez教授莅临并作专题讲座,系统介绍了AGREE工具理论框架与最新进展。本文系统介绍AGREE工具家族的历史沿革,各工具的功能定位、使用方法,并展望AGREE Ⅲ的最新研发进展,以期为中国指南的制定者、评价者及方法学研究者提供参考。

关键词: 临床实践指南, 质量评价, AGREE, 循证医学, 指南方法学

陈诗卉, 王吉耀, Ivan D.Florez, 夏君. 临床实践指南质量评价工具AGREE介绍[J]. 肝脏, 2026, 31(6): 763-767.

/ 推荐

参考文献

[1] Schünemann H J, Wiercioch W, Etxeandia I, et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise[J]. CMAJ, 2014, 186(3): E123-E142.
[2] Zheng Z, Cui S, Lu X, et al. Analysis of the status of Chinese clinical practice guidelines development[J]. BMC Health Serv Res, 2012, 12(1): 218.
[3] Zhou Q, Wang Z, Shi Q, et al. Clinical epidemiology in China series. Paper 4: the reporting and methodological quality of chinese clinical practice guidelines published between 2014 and 2018: a systematic review[J]. J Clin Epidemiol, 2021, 140: 189-199.
[4] Woolf S H, Grol R, Hutchinson A, et al. Potential benefits, limitations, and harms of clinical guidelines[J]. BMJ, 1999, 318(7182): 527-530.
[5] Anonymous. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project[J]. Qual Saf in Health Care, 2003, 12(1): 18.
[6] Cluzeau F, Littlejohns P, Grimshaw J, et al. Development and application of a generic methodology to assess the quality of clinical guidelines[J]. Int J Qual Health Care, 1999, 11(1): 21-28.
[7] Brouwers M C, Kho M E, Browman G P, et al. AGREE Ⅱ: advancing guideline development, reporting and evaluation in health care[J]. CMAJ, 2010, 182(18): E839-E842.
[8] Makarski J, Brouwers M C. The AGREE enterprise: a decade of advancing clinical practice guidelines[J]. Implement Sci, 2014, 9: 103.
[9] Anonymous. AGREE enterprise website | advancing the science of practice guidelines[EB/OL].[2026-05-30]. https://www.agreetrust.org/.
[10] Florez I D, Brouwers M C, Kerkvliet K, et al. Assessment of the quality of recommendations from 161 clinical practice guidelines using the appraisal of guidelines for research and evaluation-recommendations excellence (AGREE-REX) instrument shows there is room for improvement[J]. Implement Sci, 2020, 15(1): 79-86.
[11] Brouwers M C, Lavis J N, Spithoff K, et al. Assessment of health systems guidance using the appraisal of guidelines for research and evaluation-health systems (AGREE-HS) instrument[J]. Health Policy, 2019, 123(7): 646-651.
[12] Brouwers M C, Kho M E, Browman G P, et al. The global rating scale complements the AGREE II in advancing the quality of practice guidelines[J]. J Clin Epidemiol, 2012, 65(5): 526-534.
[13] Vernooij R W, Sanabria A J, Solà I, et al. Guidance for updating clinical practice guidelines: a systematic review of methodological handbooks[J]. Implement Sci, 2014, 9: 3.
[14] Devp_Gep. How AGREE-S was developed[EB/OL].[2026-05-30]. https://agree-s.org/how-agree-s-was-developed/.
[15] Brouwers M C, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines[J]. BMJ, 2016: i1152.
[16] Akl E, Bennett A, Bernardo W, et al. It′s time for an update: AGREE Ⅲ, the next iteration of guideline appraisal[J]. J Clin Epidemiol, 2025, 187:111935.
[17] Antoniou G A, Mavridis D, Tsokani S, et al. Protocol of an interdisciplinary consensus project aiming to develop an AGREE Ⅱ extension for guidelines in surgery[J]. BMJ open, 10(8), e037107.
[18] Antoniou S A, Tsokani S, Mavridis D, et al. Guideline assessment project: filling the GAP in surgical guidelines: quality improvement initiative by an international working group[J]. Ann Surg, 2019, 269(4): 642-651.
[19] Tsokani S, Antoniou S A, Moustaki I, et al. Guideline assessment project Ⅱ: statistical calibration informed the development of an AGREE Ⅱ extension for surgical guidelines[J]. Surg Endosc, 2021, 35(8): 4061-4068.