The quality of clinical practice guidelines in China: a systematic assessment

J Eval Clin Pract. 2013 Oct;19(5):961-7. doi: 10.1111/j.1365-2753.2012.01893.x. Epub 2012 Jul 29.


Background: Clinical guidelines are an important tool for improving service quality, the benefits of guidelines depend on their quality. In China, there has been a great increase in production of guidelines. However, little is known about their quality.

Method: We identified Chinese guidelines published between 2006 and 2010 by searching three Chinese full-text databases, major Chinese guidelines websites and Google. Three appraisers independently evaluated each guideline by using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Subgroup analyses were performed according to source, title, version, aspect of care and developer of guidelines.

Results: A total of 327 guidelines were eligible and 57 were excluded for their lacking of any account of the guideline development methodology. Of the 270 guidelines, 77 (28.5%) can be recommended, 6 (2.2%) were evidence-based guidelines. Sixteen (5.9%) guidelines described the methods used to search for evidence, 61 (22.6%) appraised the quality of evidence and 53 (19.6%) graded the strength of recommendations. Two guidelines declared the involvement of methodological experts and none reported considering patients' values. 29 (10.7%) guidelines received drug company sponsorship but only two declared the views of the funding bodies did not influence the recommendations, 259 (95.9%) didn't declare the interest conflicts of guideline developers. Guidelines downloaded from Internet and with updated versions yielded higher quality than the rest.

Conclusions: Although numerous guidelines were produced in China, the quality was generally low. Focusing on improving the quality of Chinese guidelines, rather than continuing to produce them in great quantity, is urgently needed.

Keywords: AGREE instrument; China; clinical practice guidelines; evidence-based guidelines; quality assessment; recommendation.

MeSH terms

  • China
  • Clinical Protocols / standards*
  • Evidence-Based Medicine / methods*
  • Health Services Research
  • Humans
  • Needs Assessment
  • Practice Guidelines as Topic / standards*
  • Quality Improvement / organization & administration*
  • Quality Indicators, Health Care