title: Application of Agree II Instrument for Appraisal of Postpartum Hemorrhage Clinical Practice Guidelines in Bosnia and Herzegovina.
abstract: BACKGROUND
  Federal Minister of Health and Minister of Health and Social Welfare of the Republika Srpska as a Governmental health authorities in Federation of Bosnia and Herzegovina (FBiH) and the Republika Srpska nominated/appointed health professionals as their representatives to a multidisciplinary Guidelines Adaptation Group (GAG). This group started with its work in September 2015. The main purpose of the guidelines development exercise is to develop guidelines with worldwide recognized methodology for clinical guidelines development and adaptation. At the end of this consultancy, GAG would have develop a clinical practice guideline on Postpartum hemorrhage (PPH) through the adaptation method, starting from published international clinical guidelines and adapting it according to the country specific requirements.
  
  
  METHODS
  During the process of identifying the best guideline for adaptation, the GAG had to pass several steps. One of the crucial steps was to identify the questions related to clinical practice and health policy for which answers are needed to be addressed by the guideline. These questions included relevant issues regarding the topic area such as diagnosis, prognosis, intervention, service delivery, and training. After that, six guidelines have been researched by the six members of the GAG to see if they answered the identified questions. Evaluating the methodological quality of the selected clinical guidelines was a second essential step before deciding which ones could best fit the needs and interests. AGREE II instrument has been chosen as methods for evaluating clinical guideline quality and appropriateness. Four appraisers conducted the assessment of each of the selected guidelines for PPH. All appraisers passed the training for the AGREE II instrument before conducting appraisals, as recommended by the AGREE collaboration. Each of the four guidelines was rated independently with the AGREE II tool by each appraiser.
  
  
  RESULTS
  The highest score was obtained by the WHO recommendations for postpartum hemorrhage guidelines and each of four assessors recommended it to be adapted and further implemented.
  
  
  CONCLUSIONS
  In spite of several serous attempts and two Agencies for quality improvement in BiH the whole process of guideline adaptation is still in the beginning and therefore the establishment of a strong connection with similar institutions and organizations from our region and the rest of the world is very important. Cooperation and collaboration across institutions and countries and key stakeholders have potential to significantly improve the validity and quality of the adapted guidelines and to positively influence implementation.
authors.affiliation: Agency for Quality and Accreditation in Healthcare of Federation of Bosnia and Herzegovina (AKAZ), Bosnia and Herzegovina.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Novo
authors.affiliation: Ministry of Health and Social Welfare of the Republika Srpska, Bosnia and Herzegovina.
authors.forename: Andreja
authors.initials: A
authors.lastname: Subotic-Popovic
authors.affiliation: The Republika Srpska Agency for Certification, Accreditation and Health Care Improvement (ASKVA), Bosnia and Herzegovina.
authors.forename: Savka
authors.initials: S
authors.lastname: Strbac
authors.affiliation: Clinical Centre University of Sarajevo, Clinic for Gynecology and Obstetrics, Bosnia and Herzegovina.
authors.forename: Alma
authors.initials: A
authors.lastname: Kandic
authors.affiliation: East European Institute for Reproductive Health, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Horga
keywords: AGREE instrument; appraisal of clinical practice guidelines; postpartum hemorrhage