Evaluation of guideline quality using GEM-Q.
A variety of rating instruments that evaluate the quality of practice guidelines have been published. Application of these instruments can be difficult and time-consuming. In a literature review, we identified two evaluation instruments that are comprehensive, have clearly defined constructs, and have undergone validation/testing-the Guidelines Quality Assessment Questionnaire (GQAQ) and the Appraisal Instrument for Clinical Guidelines (AICG). Overall, the AICG is more comprehensive. The AICG addresses the implementability of a guideline, which is not evaluated by the GQAQ. However, the GQAQ is more amenable to computerization. GEM-Q is a Guideline Elements Model (GEM)-derived application intended to facilitate automated evaluation of guideline quality using one of the published instruments. To develop GEM-Q, various items in the GQAQ were mapped to corresponding elements in the GEM hierarchy and a customized XSL stylesheet was designed based on this mapping. GEM-Q selectively extracts text components of the guideline relevant to quality evaluation and displays the results in HTML format. GEM-Q was applied to a set of six guidelines to test its reliability. It ranked two guidelines as of "good" quality, two as "intermediate", and two as "poor". In all six instances, GEM-Q ranked guidelines in the same order of quality as the experts who validated the GQAQ. This work demonstrates the feasibility of developing an application to facilitate automated guideline quality evaluation.
Agrawal
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Yale Center for Medical Informatics, New Haven, CT, USA. abha.agrawal@yale.edu
Shiffman
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D005069:Evaluation Studies as Topic; D005103:Expert Systems; D017410:Practice Guidelines as Topic / Q000592:standards*; D011381:Programming Languages; D011785:Quality Assurance, Health Care / Q000379:methods; D011795:Surveys and Questionnaires