National Institute for Health and Care Excellence clinical guidelines development principles and processes

Clinical guidelines are developed by professional societies and also, in England, by an independent non-departmental public body, the National Institute for Health and Care Excellence (NICE). Similarities and differences between these guidelines should be viewed in the context of different objectives, responsibilities and roles of guideline developers. This review describes the NICE clinical guidelines development principles and processes with the aim to provide the reader an informed perspective on the recommendations made. NICE clinical guidelines are developed by an appointed independent advisory committee comprising healthcare professionals as well as lay members, supported by a professional team comprising project managers, information specialists, systematic reviewers and health economists. Furthermore, registered stakeholders comprising organisations that have an interest in the guideline topic, or represent people whose practice or care may be directly affected by the guideline, are consulted on the draft scope and draft guidelines. NICE selects a limited number of high impact questions to be answered by the review of evidence, rather than cover a certain topic exhaustively as the clinical guidelines developed by professional societies may do. NICE clinical guidelines recommendations reflect both the clinical effectiveness and the cost-effectiveness of interventions.

An assessment of inter-rater agreement of the literature filtering process in the development of evidence-based dietary guidelines

ObjectiveTo determine whether the literature filtering process, a vital initial component of a systematic literature review, could be successfully completed by nutrition professionals or non-professionals.DesignUsing a diet–disease relationship as the guideline topic, inter-rater agreement for the title and abstract filtering processes between and among professionals and non-professionals was assessed and compared with an expert reference standard. Predetermined eligibility criteria were applied by all raters to 185 titles and 90 abstracts. Filtering decisions were initially made independently and then revised after a within-pair consensus meeting.SubjectsThe raters were six dietitians (RD) and six nutrition graduate students (Grad). To assess inter-rater agreement (reliability), each group was divided into three pairs.ResultsWeighted and unweighted kappa statistics and percentage agreement were calculated to determine the inter-rater agreement within pairs. Sensitivity and specificity estimates were determined by comparing responses with those of an expert reference standard. Overall, Grad pairs demonstrated greater inter-rater agreement than RD pairs for title filtering (P < 0.05); no differences were observed for abstract filtering. Compared with the expert reference standard, every rater and pair had false-negative responses for both title and abstract filtering.ConclusionsAfter consensus meetings, both RDs and Grads were comparable in their agreement on title and abstract filtering, although important differences remained compared with the expert reference standard. This study provides preliminary findings on the value of utilising a non-expert pair in developing guidelines, and suggests that the literature filtering process is complex and quite subjective.