临床实践指南是指系统开发的声明，帮助医务人员及患者在特定临床情境下做出恰当决策的指导性意见。指南制定过程的科学性和规范性直接影响指南的质量和可靠性，有必要对指南质量进行评价。指南研究与评价工具II (Appraisal of Guidelines for Research & Evaluation, AGREE II)是应用最为广泛的临床实践指南质量评价工具。本文主要介绍AGREE II概述。
AGREE II的使用详见临床实践指南质量评价——指南研究与评价工具II (Appraisal of Guidelines for Research & Evaluation, AGREE II) (二)
AGREE II评价清单详见临床实践指南质量评价——指南研究与评价工具II (Appraisal of Guidelines for Research & Evaluation, AGREE II) (三)
AGREE II评价清单详细内容的“领域 1. 范围和目的”和“领域 2. 参与人员”详见临床实践指南质量评价——指南研究与评价工具II (Appraisal of Guidelines for Research & Evaluation, AGREE II) (四)
AGREE II评价清单详细内容的“领域 3. 开发的严谨性”详见临床实践指南质量评价——指南研究与评价工具II (Appraisal of Guidelines for Research & Evaluation, AGREE II) (五)
AGREE II评价清单详细内容的“领域 4. 表达的明晰性”和“领域 5. 应用性”详见临床实践指南质量评价——指南研究与评价工具II (Appraisal of Guidelines for Research & Evaluation, AGREE II) (六)
AGREE II评价清单详细内容的“领域 6. 独立性”和“指南全面评价”详见临床实践指南质量评价——指南研究与评价工具II (Appraisal of Guidelines for Research & Evaluation, AGREE II) (七)
关键词：临床实践指南质量评价; 指南研究与评价工具; AGREE Ⅱ
一、AGREE II概述
指南研究与评价工具(The Appraisal of Guidelines for Research & Evaluation, AGREE)是用于评估指南开发方法是否严谨和透明的工具，旨在帮助评估说明各临床实践指南的质量差别。AGREE是由国际指南开发和研究组织——AGREE 协作组于2003年首发，并于2009年修订发布AGREE Ⅱ，最近更新日期为2017年11月。AGREE Ⅱ包括6个领域，共23个条目及2个全面评价条目。旧版AGREE条目和AGREE II条目对比详见表1。
表1 旧版AGREE条目和AGREE II条目对比
| Domain 领域 | Original AGREE Item 旧版AGREE条目 | AGREE II Item AGREE II 条目 |
| Domain 1. Scope and Purpose 领域 1. 范围和目的 | 1. The overall objective(s) of the guideline is (are) specifically described. | No change |
| 译文：1. 明确描述指南的总目的 | 没有改变 | |
| 2. The clinical question(s) covered by the guideline is (are) specifically described. | The health question(s) covered by the guideline is (are) specifically described. | |
| 译文：2. 明确描述指南涵盖的临床问题 | 明确描述指南涵盖的健康问题 | |
| 3. The patients to whom the guideline is meant to apply are specifically described. | The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described. | |
| 译文：3. 明确描述指南应用的患者 | 明确描述指南的使用人群(患者、普通人群等) | |
| Domain 2. Stakeholder Involvement 领域 2. 参与人员 | 4. The guideline development group includes individuals from all the relevant professional groups. | No change |
| 译文：4. 指南制定小组涵盖了所有相关专业组织的成员 | 没有改变 | |
| 5. The patients’ views and preferences have been sought. | The views and preferences of the target population (patients, public, etc.) have been sought. | |
| 译文：5. 征询了患者的观点和选择意愿 | 收集了使用人群(患者、普通人群等)的观点和选择意愿 | |
| 6. The target users of the guideline are clearly defined. | No change | |
| 译文：6. 明确了指南的使用者 | 没有改变 | |
| 7. The guideline has been piloted among end users. | Delete item. Incorporated into user guide description of item 19. | |
| 译文：7. 指南已在适用人群中试用 | 删除这一条，将其合并入条目19 | |
| Domain 3. Rigour of Development 领域 3. 开发的严谨性 | 8. Systematic methods were used to search for evidence. | No change in item. Renumbered to 7. |
| 译文：8. 应用系统的方法检索证据 | 条目没有改变，重新编号为条目7 | |
| 9. The criteria for selecting the evidence are clearly described. | No change in item. Renumbered to 8. | |
| 译文：9. 清楚描述选择证据的标准 | 条目没有改变，重新编号为条目8 | |
| NEW Item 9. The strengths and limitations of the body of evidence are clearly described. | ||
| 新条目9. 清楚描述证据的优点和局限性 | ||
| 10. The methods for formulating the recommendations are clearly described. | No change | |
| 译文：10. 清楚描述形成推荐建议的方法 | 没有改变 | |
| 11. The health benefits, side effects, and risks have been considered in formulating the recommendations. | No change | |
| 译文：11. 形成推荐建议时考虑了对健康的益处、副作用和风险 | 没有改变 | |
| 12. There is an explicit link between the recommendations and the supporting evidence. | No change | |
| 译文：12. 推荐建议和支持证据之间有明确联系 | 没有改变 | |
| 13. The guideline has been externally reviewed by experts prior to its publication. | No change | |
| 译文：13. 指南在发布前经过专家的外部评审 | 没有改变 | |
| 14. A procedure for updating the guideline is provided. | No change | |
| 译文：14. 提供指南更新的步骤 | 没有改变 | |
| Domain 4. Clarity of Presentation 领域 4. 表达的清晰性 | 15. The recommendations are specific and unambiguous. | No change |
| 译文：15. 推荐建议明确不含糊 | 没有改变 | |
| 16. The different options for management of the condition are clearly presented. | The different options for management of the condition or health issue are clearly presented. | |
| 译文：16. 明确列出针对某一病情的不同选择 | 明确列出针对某一病情或健康问题的不同选择 | |
| 17. Key recommendations are easily identifiable. | No change | |
| 译文：17. 主要的推荐建议清晰易辨 | 没有改变 | |
| Domain 5. Applicability 领域 5. 应用性 | 18. The guideline is supported with tools for application. | The guideline provides advice and/or tools on how the recommendations can be put into practice. AND Change in domain (from Clarity of Presentation) AND renumbered to 19 |
| 译文：18. 有支持应用指南的工具 | 指南提供了推荐建议如何应用于实践的建议和/或配套工具。并且领域有改变(原自清晰性)，重新编号为19 | |
| 19. The potential organizational barriers in applying the recommendations have been discussed. | The guideline describes facilitators and barriers to its application. AND change in order – renumbered to 18 | |
| 译文：19. 指南讨论了推荐建议应用过程中可能遇到的潜在阻碍因素 | 指南描述了应用过程中的促进和阻碍因素。改变了排列序号，重新编号为18 | |
| 20. The potential cost implications of applying the recommendations have been considered. | The potential resource implications of applying the recommendations have been considered. | |
| 译文：20. 指南考虑了应用推荐建议时潜在的费用问题 | 指南考虑了应用推荐建议时潜在的资源投入问题 | |
| 21. The guideline presents key review criteria for monitoring and/or audit purposes. | The guideline presents monitoring and/or auditing criteria. | |
| 译文：21. 指南提供了关键的监督和/或审查标准 | 指南提供监督和/或审查的标准 | |
| Domain 6. Editorial Independence 领域 6. 编辑的独立性 | 22. The guideline is editorially independent from the funding body. | The views of the funding body have not influenced the content of the guideline. |
| 译文：22. 指南编辑应独立于赞助单位 | 赞助单位的观点不影响指南内容 | |
| 23. Conflicts of interest of guideline development members have been recorded. | Competing interests of guideline development group members have been recorded and addressed. | |
| 译文：23. 指南记录了制定小组成员的利益冲突 | 指南记录并处理了制定小组成员的利益冲突 |
AGREE II 可用于评价不同级别(地方、国家、国际组织或联合政府组织发布)的各种初版和更新版指南，适用于包括预防、健康促进、健康教育、诊断、治疗、干预、康复等卫生保健环节中任何疾病领域。AGREE II的使用者包括：卫生保健提供者、指南制定者、卫生决策者和相关教育工作者。对于卫生保健提供者，建议在采纳指南推荐的建议之前，自己先根据AGREE II对指南进行评价；对于指南开发者，使用AGREE II作为自我评价工具，可促使遵循结构化、严格开发流程以确保指南的健全，或科学评价其他指南，以便改版形成自身需要的指南；对政策制定者，可以帮助决定哪些指南可以被推荐实际应用或有助于政策的决定；对于教育者，可以帮助卫生专业人员提高严格评估指南的技能，以及教授指南开发和报告的核心能力。
注：本文内容是参考相关文献后对指南研究与评价工具II (Appraisal of Guidelines for Research & Evaluation, AGREE II)的概述，仅代表本网站观点。关于AGREE II的更多内容详见网站http://www.agreetrust.org/。