Abstract：
We assessed the methodological quality and transparency of all the national clinical practice guidelines that were published in Croatia up until 2017 and explored the factors associated with their quality rating. An in-depth quantitative and qualitative analysis was performed using rigorous methodology. We evaluated the guidelines using a validated AGREE II instrument with four raters; we used multiple linear regressions to identify the predictors of quality; and two focus groups, including guideline developers, to further explore the guideline development process. The majority of the guidelines (N = 74) were developed by medical societies. The guidelines\' quality was rated low: the median standardized AGREE II score was low, 36% (IQR 28-42), and so were the overall-assessments. The aspects of the guidelines that were rated best were the \"clarity of presentation\" and the \"scope and purpose\" (median ≥ 59%); however, the other four domains received very low scores (15-33%). Overall, the guideline quality did not improve over time. The guidelines that were developed by medical societies scored significantly worse than those developed by governmental, or unofficial working groups (12-43% per domain). In focus group discussions, inadequate methodology, a lack of implementation systems in place, a lack of awareness about editorial independence, and broader expertise/perspectives in working groups were identified as factors behind the low scores. The factors identified as affecting the quality of the national guidelines may help stakeholders who are developing interventions and education programs aimed at improving guideline quality worldwide.
摘要：
我们评估了截至2017年在克罗地亚发布的所有国家临床实践指南的方法学质量和透明度，并探讨了与其质量评级相关的因素。使用严格的方法进行了深入的定量和定性分析。我们使用经过验证的AGREEII工具与四名评估者进行了评估；我们使用多元线性回归来确定质量的预测因素；以及两个焦点小组，包括指南开发人员，进一步探索指导方针的制定过程。大多数指南（N=74）是由医学协会制定的。指南质量被评为低：中位数标准AGREEII评分低，36%(IQR28-42)，总体评估也是如此。被评为最佳的指南方面是“表述的清晰度”和“范围和目的”（中位数≥59％）；但是，其他四个领域的得分非常低(15-33%)。总的来说,指南质量没有随着时间的推移而改善.医学协会制定的指南得分明显低于政府制定的指南，或非官方工作组（每个域12-43％）。在焦点小组讨论中，方法不足，缺乏实施系统，缺乏对编辑独立性的认识，工作组中更广泛的专业知识/观点被确定为低分背后的因素。被确定为影响国家指南质量的因素可能有助于正在制定旨在提高全球指南质量的干预措施和教育计划的利益相关者。
