ADMISSION-CPA: Guideline Review Matrix and Guideline Recommendations

<p dir="ltr">The ADMISSION collaborative is a UK Research and Innovation (UKRI) and UK-based National Institute for Health and Care Research (NIHR)-funded programme aiming to improve care for people with Multiple Long Term Conditions (MLTC) admitted to hospital. Based across five UK academic centres, ADMISSION brings together clinical, data, social, and computational sciences in partnership with public contributors. Our work package (ADMISSION-CPA*) focuses on understanding how healthcare professionals make decisions about referrals, admissions, and care for people with MLTC in secondary care.</p><p dir="ltr">*Care Pathway analysis. </p><p dir="ltr">Clinical guidelines have long been criticised for focusing on single conditions, with limited consideration of multimorbidity. Prior reviews across multiple countries, including the UK, have shown that guidelines rarely address multiple long-term conditions (MLTC) explicitly, often overlook discordant comorbidities, and seldom incorporate patient preferences or treatment burden. Recommendations for improvement have been proposed, but it remains unclear how widely these have been adopted in practice across current UK guidelines.</p><p><br></p><p dir="ltr">Objective:</p><p dir="ltr">To evaluate how UK guidelines for individual health conditions consider co-existing conditions and multiple chronic health problems, and to explore how guideline development processes, such as committee composition, may influence the inclusion of MLTC-relevant guidance.</p><p dir="ltr">Key questions addressed were:</p><ol><li>To what extent are co-existing conditions and MLTC considered in NICE single-condition guidelines?</li><li>What is the nature of the recommendations related to co-existing conditions and MLTC?</li><li>To what extent do the guidelines address concordant and discordant conditions?</li><li>How are guideline development committees structured?</li><li>Which guidelines serve as exemplars of good practice in guideline development?</li></ol><p><br></p><p dir="ltr">Methods:</p><p dir="ltr">We reviewed 56 clinical guidelines developed by the National Institute for Health and Care Excellence (NICE). For each guideline, we extracted data on references to co-existing conditions and MLTC, the nature and frequency of recommendations provided, and the composition of guideline committees. Based on our findings, we proposed recommendations for improving guideline relevance for MLTC.</p><p dir="ltr">Results:</p><p dir="ltr">We reviewed 56 NICE clinical guidelines published between 2013 and 2024, covering a broad range of long-term conditions. Most guidelines (55/56) included some advice on managing the index condition in the presence of co-existing conditions, and 50 offered general guidance on tailoring care. However, only 11 guidelines explicitly referred to multiple long-term conditions (MLTC), and none included a dedicated section on MLTC or how care should be adapted in this context. Nineteen guidelines featured sections addressing co-existing conditions, though only two focused on tailoring care without specifying particular conditions. Coverage of co-existing conditions varied widely across condition categories, with mental health guidelines addressing the greatest number and cancer and eye disease guidelines the fewest. Guidelines more frequently considered concordant conditions (conditions affecting the same organ system as the index condition covered by the guideline) than discordant conditions (additional health conditions that do not belong to the same organ system as the index condition), despite these representing a minority of the conditions that are likely to co-occur with a primary condition. Committee composition data showed wide variation in size, disciplinary diversity, and inclusion of generalist clinicians and public contributors, though lived experience of MLTC was rarely specified.</p><p dir="ltr">These files are supplementary to the guideline review described above:</p><p dir="ltr">1) Matrix of co-existing condition and MLTC-relevant content across NICE clinical guidelines</p><p dir="ltr">2) Complete list of recommendations addressing co-existing long-term conditions from 56 NICE clinical guidelines</p><p><br></p>