Endocrine clinical practice guidelines in North America. A systematic assessment of quality

Abstract 

Objective

To assess the quality of endocrine guidelines developed in North America.

Study Design and Setting

A systematic review of the literature was conducted to identify all endocrine clinical practice guidelines developed in North America and published between January 1, 2007 and January 13, 2010. Two independent reviewers used the Appraisal of Guidelines, Research and Evaluation instrument to evaluate the quality of the guidelines in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence.

Results

One hundred eligible endocrine guidelines had high scores in the scope-and-purpose (mean pooled standardized score [MPSD] of 82±14) and clarity domains (MPSD=64±17) and low scores in the stakeholder-involvement (MPSD of 36±12) and editorial independence domains (MPSD=36±36). Only 29% of guidelines scored above 60% for more than three domains. Rigor-of-development domain score was significantly higher in guidelines using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach, nondiabetes guidelines, and in published in-print vs. online publications.

Conclusions

The quality of endocrine guidelines published in 2007–2009 is moderate and can be improved by (1) using methodologically sound development frameworks, (2) increasing stakeholder involvement, and (3) paying more attention to resource implications of guideline implementation.

Keywords: Endocrine guideline, Clinical practice, AGREE instrument, Quality, Systematic review, GRADE