Tool for grading public health interventions (NICE Tool)

This tool for summarizing and disseminating evidence was created by the National Institute for Clinical Excellence (NICE) for its public health best practice guidelines recommendations. Developers undertook literature and website searches, and consulted with experts and researchers to create this evidence-grading tool. This tool gives a practical and transparent means of assigning a grade to the quality of evidence used to create recommendations for public health practice.

Before a practice recommendation is assigned a grade, the following factors are considered:

• the quality of the available evidence;
• the consistency of the intervention results across various studies;
• the relevance of the health outcome to public health;
• the feasibility and plausibility of the proposed intervention;
• the cost of the proposed intervention

This tool was created specifically for public health and helps to guide front-line public health workers with the best evidence available for their practice.

Steps for Using Method/Tool

Explicit steps for using this tool were not provided by the authors of the source documents. Those implementing the tool would review the available evidence for the practice recommendation and assign a grade letter and quality level. The efficacy of the evidence, as well as how well the studies were carried out to support the practice recommendation, was rated with a numerical level from 1 to 4 (1 being the highest).

A rating of 1 indicates the most appropriate and highest quality of evidence which could include meta- analyses, systematic reviews or randomized controlled trials.

A rating of 4 comprises expert opinion and formal consensus methods. Further, the evidence supporting the practice recommendation is assigned a letter grade for the class of the recommendation.

For example, a practice recommendation with a grade of A 1++ indicates that the public health intervention recommendation is based on results from at least one well-designed research method such as a meta-analysis, systematic review or randomized, controlled trial. A weaker grade of D 4 could indicate that the practice recommendation was based on the clinical experience of experts or on methods to achieve consensus among experts.