Volume 146, Issue 1, Pages 182-192 (July 2014) Methodologies for the Development of CHEST Guidelines and Expert Panel Reports  Sandra Zelman Lewis, PhD, Rebecca Diekemper, MPH, Joseph Ornelas, PhD, Kenneth R. Casey, MD, MPH, FCCP  CHEST  Volume 146, Issue 1, Pages 182-192 (July 2014) DOI: 10.1378/chest.14-0824 Copyright © 2014 The American College of Chest Physicians Terms and Conditions

Figure 1 – COI grid template. This spreadsheet is used to keep track of which panelists have conflicts of interests relevant to which recommendations. It allows staff and panel leadership to prevent voting by conflicted panelists whose conflicts are being managed. COI = conflict of interest. CHEST 2014 146, 182-192DOI: (10.1378/chest.14-0824) Copyright © 2014 The American College of Chest Physicians Terms and Conditions

Figure 2 – Grading of Recommendations Assessment, Development, and Evaluation (GRADE) grid. The GRADE grid is used for voting on a proposed recommendation or suggestion and for achieving panel consensus. This five-point Likert scale allows panelists to express strong or weak support for or against the proposed clinical statement. To achieve consensus, at least 80% of the voters must vote positively, which includes both strong and weak agreement combined. CHEST 2014 146, 182-192DOI: (10.1378/chest.14-0824) Copyright © 2014 The American College of Chest Physicians Terms and Conditions

Figure 3 – Continuum of supporting evidence. This illustrates the continuum of research data that can support an evidence-based guideline when the evidence is of higher-level quality (toward the right side) or will require the consensus of an expert panel when the evidence is too low (toward the left side) to support the more rigorous methodology of a guideline. The hybrid approach is used when there are topics that span this continuum in the same project. As the scientific evidence evolves, it might increase the likelihood that an evidence-based guideline methodology could be followed. Thus, evolving evidence moves toward the right on this continuum as more scientific papers are published on a topic. CHEST 2014 146, 182-192DOI: (10.1378/chest.14-0824) Copyright © 2014 The American College of Chest Physicians Terms and Conditions