Methodology

The ARCADE consensus process uses the RAND/UCLA Appropriateness Method, a formal structured approach for synthesising scientific evidence and expert opinion.

Overview

The RAND/UCLA Appropriateness Method combines a systematic literature review with expert panel voting to determine whether clinical recommendations are appropriate for specific indications. The method has been validated across numerous clinical domains and is widely used in guideline development.

Voting Scale

Panelists rate each statement on a 1–9 scale:

Consensus Classification

For each statement, the final classification is determined as follows:

• Appropriate: Median score 7–9 without disagreement.
• Inappropriate: Median score 1–3 without disagreement.
• Uncertain: Median score 4–6, or disagreement present regardless of median.

Disagreement

Disagreement is present when ≥ 1/3 of votes fall in the 1–3 range AND ≥ 1/3 fall in the 7–9 range simultaneously, regardless of the median. This follows the standard RAND/UCLA threshold.

Round Structure

1. Round 1: All statements are rated independently.
2. Review: Statements with uncertain classification or disagreement are reviewed by the steering committee and may be revised.
3. Round 2: Uncertain statements are re-rated after feedback from Round 1 and any revisions.
4. Round 3 (optional): Applied only if predefined criteria are met.

Privacy

All votes are anonymous. Individual responses cannot be linked to panelists. Only aggregate results are reported in the final publication.

Reference

Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User's Manual. Santa Monica, CA: RAND Corporation; 2001.