NICE guideline process earns international praise
NICE guidelines are among the most "trustworthy" in the world and meet a series of rigorous standards, a leading journal has concluded.
An editorial published this week in the prestigious US journal Annals of Internal Medicine praises NICE for the way in which it produces its guidance.
Guideline topics are selected on the basis of many factors, including the burden of disease, the impact on resources, and whether there is inappropriate variation in practice across the country.
NICE then commissions four external centres and one internal centre to produce clinical guidelines on its behalf, according to the topic area.
The National Clinical Guideline Centre is the largest of these centres; it was established in 2009 from a merger of 4 smaller guideline-producing centres specialising in acute care, chronic conditions, primary care, and nursing and supportive care.
The other three external centres that currently produce guidance are the National Collaborating Centre for Cancer, the National Collaborating Centre for Women's and Children's Health, and the National Collaborating Centre for Mental Health.
The editorial, written by the editors of the journal, commends the use of clinical guidelines for the role they play in helping to improve patient care, but warns that the development of thousands of clinical practice guidelines by hundreds of groups in dozens of countries is making it hard for doctors to work out which guidelines to trust.
"Guidelines could very well become part of the vey problem they aim to solve. How can busy clinicians struggling to do what is best for their patients identify guideline that they can trust?" they argue.
To help overcome this problem, the American Institute of Medicine (IOM) has proposed a series of standards that should be met by all trustworthy guidelines.
This includes following a transparent process that minimises bias, distortion and conflicts of interest, using a rigorous evidence review, and having a mechanism in place for revision when new evidence becomes available.
The IOM criteria sets a high bar, and strict application of the standards would classify many, if not most clinical guidelines as untrustworthy.
Focusing on the recent NICE guideline for the prevention of delirium, the editorial praises NICE and states that the NICE process “comes close to meeting the IOM's rigorous definition of trustworthy”.
As a result, the journal plans to publish future guidelines from NICE so that they can reach a wider audience that extends well beyond the 140,000 doctors who are members of the journal.
The editorial concludes that “current, high-quality practice guidelines promote excellence in care, and we are glad to provide a venue for their wide dissemination and discussion.”
10 June 2011