Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

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instrument with documented reliability and validity, found that the availability
of background information was the strongest predictor of guideline quality and
that high-quality guidelines were more often produced by government-supported
organizations or a structured, coordinated program (Fervers et al., 2005). The
AGREE instrument, revised in 2013, now has 23 items and is organized into six
domains (The AGREE Research Trust, 2013; Brouwers et al., 2010):

1. Scope and purpose


2. Stakeholder involvement


3. Rigor of development


4. Clarity of presentation


5. Applicability


6. Editorial independence

The National Guideline Clearinghouse (NGC), an initiative of the Agency for
Healthcare Research and Quality (AHRQ), U.S. Department of Health and Hu-
man Services, is another excellent source of high-quality guidelines and is known
for its rigorous standards. The NGC recently revised the criteria designed to en-
sure rigor in developing and maintaining published guidelines (NGC, 2013). The
revised criteria stipulate that the guidelines:

■■ Contain systematically developed statements, including recommendations

to optimize patient care and assist physicians and/or other healthcare

practitioners and patients to make decisions

■■ Have been produced by a medical specialty association, relevant profes-

sional society, public or private organization, government agency, or

healthcare organization or plan

■■ Be based on a systematic review of evidence

■■ Contain an assessment of the benefits and harms of recommended care

and alternative care options