Project title:Sistema Nazionale Linee Guida (SNLG): the Italian  National Guidelines System

Durata del progetto: 2017 up to date


Project Summary

Law No. 24/2017 on professional responsibility has assigned a fundamental role to clinical practice guidelines, giving the Istituto Superiore di Sanità, through the new Centro Nazionale per l’Eccellenza Clinica, la Qualità e la Sicurezza delle Cure (CNEC), the role of methodological guarantor and of national governance of the clincial guidelines production process.

In this framework, the new Italian  National Guidelines System was established as the pivotal instrument to to promote an efficient production mechanism of good quality national guidelines, informed by the best evidence available and responding to the population health needs, based on the criteria of relevance and clinical, economic and social impact.

To achieve these objectives, the CNEC-ISS has developed the methodological standards recommended for the production and critical evaluation of LG intended to be published on the SNLG website.

In particular, the ISS Methodological Manual for the Production of Clinical Practice Guidelines had adopted the GRADE methodology

(Grading of Recommendations, Assessment, Development and Evaluations), that is a transparent framework for developing and presenting summaries of evidence and provides a systematic approach for making clinical practice recommendations. It is the most widely adopted tool for grading the quality of evidence and for making recommendations with over 100 organizations worldwide officially endorsing GRADE.


Main topic

Clinical practice guidelines development and evaluation.


Title of WP or Activity

Health equity issues in clinical practice guidelines


WP/Activity Summary

Health equity is widely recognized as relevant to clinical/public health practice and health policy. Given the potential for recommendations to have differential impact on different social groups, it is important to consider equity in the process of health guideline development.

Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering health equity in the process of guideline development, rating certainty and going from evidence to decision. Indeed, the GRADE EtD frameworks support explicit judgments about the main factors that influence the strength of recommendations, including impact on health equity. These criteria include the priority of the problem, how substantial desirable and undesirable health effects are, certainty of the evidence of effects, how people value the main outcomes, whether desirable effects outweigh undesirable health effects, resource requirements and whether the net health benefits are worth the incremental cost, impact on equity, acceptability to stakeholders, and feasibility of the intervention.


Expected results

Guidelines can contribute to advancing health equity globally by explicit consideration of the impact of individual patient/clinician/policy-maker decisions on health equity. By making explicit the discussion regarding how different equity factors affect the direction and strength of recommendations, GRADE helps inform the desired fair and deliberative process and documents considerations that may impact on individual patient/clinician/policy-maker decisions.


Responsible of the project: Primiano Iannone (

Responsible of the WP/Activity: Primiano Iannone (

Department/Center: Centro per l’eccellenza clinica la qualità e la sicurezza delle cure

Project website: