Utilidad del instrumento AGREE para la elaboración y la evaluación de protocolos clínicos: de la teoría a la práctica clínica

Introduction and objective

Clinical protocols are tools for the delivery of optimal and quality healthcare. However, there are often shortcomings in the quality of their design that invalidate their implementation. The aim of this study is to describe a systematic evaluation of clinical protocols, to analyse their quality in order to enable their implementation.

Materials and methods

Descriptive study that included the clinical protocols assessed by the Committee of Reviewers of Clinical Practice Recommendations and Health Technologies of a tertiary hospital during 11 years of its existence between 2013 and 2023. The AGREE instrument was used to assess the quality of the protocols received, calculating standardised scores by item and domain, and categorising them into: a) excellent (90-100%), b) good (70-89%), c) improvable (50-69%), d) very improvable (30-49%), e) deficient (10-29%), and f) very deficient: 0-9%.

Results

Of the 59 documents received by the Commission, 32 were subsidised for AGREE evaluation. The highest scoring domain was «Scope and objective», with excellent scores for 29 protocols; the remaining domains had scores ranging from 58.5%-100% for «Rigour in elaboration» and 0-100% for «Independence». By items, scores ranged from 85.7-100% for «Target users of the protocol are clearly defined» to 0-100% for the items «Potential costs of implementing recommendations» and «Conflict of interest». Of the 32 protocols, 9 were highly recommended, 22 were recommended with modifications/conditions and one was not recommended.

Conclusions

The AGREE tool makes it possible to systematize both the drafting of clinical protocols by the authors and their evaluation by the Clinical Practice Recommendations and Health Technologies Review Committee. This makes it possible to have applicable and quality protocols in our hospital, which results in an improvement in the quality of healthcare.