Quality Appraisal of Evidence-based Clinical Practice Guidelines Developed in Taiwan
2Cochrane Taiwan, Taipei Medical University, Taiwan
3Department of Public Health, School of Medicine, College of Medicine, Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan & Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
4School of Nursing, College of Nursing, Taipei Medical University; Cochrane Taiwan; Department of Nursing, Wan Fang Hospital; Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
5Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan & Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taiwan
Background: Developing high-quality Clinical Practice Guidelines (CPGs) requires rigorous and transparent methodology with updating in due time for optimum healthcare decisions. The development of CPGs in Taiwan is booming, and the guideline development methodologies are diverse. The quality of CPGs has yet to be systematically evaluated.
Objectives: To systematically review the quality of evidence-based CPGs developed in Taiwan.
Methods: Using “Guideline” [Publication Type], “Guidelines” as keywords, search for Cochrane, PubMed, EMBASE, CINAHL, international guideline website, Government Research Bulletin, 2 Chinese databases, and Google Scholar. For developed CPGs, The Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) was used for evaluation by two researchers with a third expert in case of ≧ 3 points difference in score.
Results: A total of 96 CPGs included after the screening. The guideline developers were professional societies (n=46), individual research or thesis (n=39), hospitals (n=9), and government (n=2). Of these, 36% receive funding from government agencies, 51.3% CPGs mentioned the evidence synthesis methodology and clinical recommendation generation, and only 4 use the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. The published CPGs do not present any document or statements regarding conflicts of interest of the guideline development group. Moreover, only 14% of published CPGs have been updated. The standardized score of AGREE II in the six domains was Scope and purpose (81%), Stakeholder involvement (55%), Rigour of development (47%), Clarity of presentation (63%), Applicability (31%), and Editorial independence (22%). The overall quality was 4.5 points (Figure 1).
Conclusions: Due to the lack of a CPGs coordinating center, there is still room for improvement in Taiwan's CPGs development. For CPGs projects funded by government agencies, it is challenging to promote CPGs application and update due to a lack of funding and staffing at the end of the project. Establishing a national-level guideline development center, promoting Evidence-based CPGs Development Methodologies and developing a sustainable funding method to support high-quality CPGs development on essential health issues are the goals for future efforts.
Patient, public and/or healthcare consumer involvement: Not applicable.