Development of the Scientific, Transparent and Applicable Rankings (STAR) tool for clinical practice guidelines

Nan Yang; Hui Liu; Wei Zhao; Yang Pan; Xiangzheng Lyu; Xiuyuan Hao; Xiaoqing Liu; Wen'an Qi; Tong Chen; Xiaoqin Wang; Boheng Zhang; Weishe Zhang; Qiu Li; Dong Xu; Xinghua Gao; Yinghui Jin; Feng Sun; Wenbo Meng; Guobao Li; Qijun Wu; Ze Chen; Xu Wang; Janne Estill; Susan L Norris; Liang Du; Yaolong Chen; Junmin Wei

doi:10.1097/CM9.0000000000002713

Development of the Scientific, Transparent and Applicable Rankings (STAR) tool for clinical practice guidelines

Chin Med J (Engl). 2023 Jun 20;136(12):1430-1438. doi: 10.1097/CM9.0000000000002713. Epub 2023 May 16.

Authors

Nan Yang^{1

2}, Hui Liu^{2

3}, Wei Zhao⁴, Yang Pan⁵, Xiangzheng Lyu⁶, Xiuyuan Hao⁷, Xiaoqing Liu⁸, Wen'an Qi⁹, Tong Chen¹⁰, Xiaoqin Wang¹¹, Boheng Zhang¹², Weishe Zhang¹³, Qiu Li¹⁴, Dong Xu¹⁵, Xinghua Gao¹⁶, Yinghui Jin¹⁷, Feng Sun¹⁸, Wenbo Meng¹⁹, Guobao Li²⁰, Qijun Wu²¹, Ze Chen¹, Xu Wang²², Janne Estill^{1

2}, Susan L Norris²³, Liang Du²⁴, Yaolong Chen^{1

25

26}, Junmin Wei²⁷

Affiliations

¹ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China.
² Institute of Global Health, University of Geneva, Geneva 1202, Switzerland.
³ School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China.
⁴ Editor-in-Chief Office, Chinese Medical Association Publishing House, Beijing 100052, China.
⁵ Marketing Department, Chinese Medical Association Publishing House, Beijing 100052, China.
⁶ Editorial Department, National Medical Journal of China, Chinese Medical Association Publishing House, Beijing 100052, China.
⁷ Editorial Department, Chinese Medical Journal, Chinese Medical Association Publishing House, Beijing 100052, China.
⁸ Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
⁹ Editorial office of Digital Medicine and Health, Chinese Medical Association Publishing House, Beijing 100052, China.
¹⁰ Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, China.
¹¹ Evidence-based Medicine Center, Fudan University, Shanghai 200032, China.
¹² Department of Hepatic Oncology, Xiamen Clinical Research Center for Cancer Therapy, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian 361015, China.
¹³ Department of Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
¹⁴ Department of Nephrology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
¹⁵ SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, Guangdong 510515, China.
¹⁶ Department of Dermatology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China.
¹⁷ Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.
¹⁸ School of Public Health, Peking University, Beijing 100191, China.
¹⁹ Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
²⁰ Department of Lung Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong 518112, China.
²¹ Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
²² Chevidence Lab of Child and Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
²³ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon 97239, USA.
²⁴ Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
²⁵ Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China.
²⁶ Guidelines and Standards Research Center, Chinese Medical Association Publishing House, Beijing 100052, China.
²⁷ Chinese Medical Association Publishing House, Beijing 100052, China.

Abstract

Background: This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability.

Methods: This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument's intrinsic and interrater reliability, content and criterion validity, and usability.

Results: STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach's α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen's kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson's r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min.

Conclusion: The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.

MeSH terms

Humans
Practice Guidelines as Topic
Reproducibility of Results*
Surveys and Questionnaires