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These findings are consistent with other studies exploring the quality of guideline development [ 24- 27].
The AGREE II appraisal process was used to assess the quality of guideline development.
However studies have raised concerns about the quality of guideline development, and particularly the link between research and recommendations.
The patient sample was dichotomised based on a clinically relevant threshold of 70% adherence rate to assess the association of ICU mortality and quality of guideline adherence.
We used the AGREE instrument as a tool for evaluating the quality of guideline development in social insurance medicine, a procedure that, to our knowledge, is new.
Several international collaborative initiatives, aiming to increase quality of guideline development, have been undertaken during the last decade (e.g. AGREE Consortium, GRADE working group) [ 18- 21].
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The Appraisal of Guidelines for Research and Evaluation (AGREE) II is the second version of the original AGREE instrument to assess the quality of guidelines in terms of development process.
To appraise the quality of guidelines developed by the World Health Organization (WHO) that were approved by its Guidelines Review Committee (GRC) and identify strengths and weaknesses in the guideline development process.
We believe this approach to be an important step towards an increase in the quality of guidelines and also a tool to make "guideline writers" aware of the responsibility of making their recommendations work.
How should the quality of guidelines or recommendations be appraised?
The use and quality of guidelines for guidelines varies across organizations that develop guidelines.
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