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Factors Associated with the Quality and Transparency of National Guidelines: A Mixed-Methods Study.

Tanja Kovačević1,2, Davorka Vrdoljak3,4, Slavica Jurić Petričević5

  • 1Department of Pediatrics, University Hospital of Split, 21000 Split, Croatia.

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Croatian clinical practice guidelines published by 2017 had low methodological quality. Key factors identified for improvement include enhancing methodology and ensuring broader expertise in working groups.

Keywords:
clinical practice guidelineseducationfocus groupguideline developmentknowledgemethodological qualitynational guidelinespublic health

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Area of Science:

  • Health Sciences
  • Medical Research
  • Clinical Practice Guidelines

Background:

  • National clinical practice guidelines (CPGs) are crucial for evidence-based healthcare.
  • Assessing the quality of CPGs is essential for their effective implementation and impact.

Purpose of the Study:

  • To evaluate the methodological quality and transparency of Croatian national CPGs published up to 2017.
  • To identify factors influencing the quality of these guidelines.

Main Methods:

  • Quantitative and qualitative analysis of 74 national CPGs using the AGREE II instrument with four raters.
  • Multiple linear regression to identify quality predictors.
  • Two focus groups with guideline developers to explore the development process.

Main Results:

  • Low overall quality of CPGs, with a median standardized AGREE II score of 36%.
  • Highest scores for "clarity of presentation" and "scope and purpose" (≥59%), but low scores (15-33%) in other domains.
  • No improvement in guideline quality over time; guidelines from medical societies scored significantly lower than others.

Conclusions:

  • Croatian national CPGs exhibit significant quality deficits, particularly in methodology and transparency.
  • Inadequate methodology, lack of implementation support, and limited expertise in working groups contribute to low quality.
  • Findings can inform targeted interventions to improve CPG quality globally.