Idiopathic Pulmonary Fibrosis Guideline Recommendations. Need for Adherence to Institute of Medicine Methodology?

Rationale: The 2018 idiopathic pulmonary fibrosis (IPF) guidelines were developed using an approach that adhered to the Institute of Medicine (IOM) standards, in which each recommendation was informed by a systematic review. The convergence of opinion on recommendations and evidence (CORE) process is a modified Delphi process that does not require a systematic review but yields similar recommendations. Objectives: To determine the importance of systematic reviews to the recommendations made by the IPF guidelines. Methods: IPF experts who were not on the IPF guideline panel and had no knowledge of the guideline's evidence synthesis or recommendations were recruited to answer the same questions as the guidelines but using a modified CORE process. Recommendations derived from the modified CORE process and IOM-adherent process were then compared. Concordance of the course of action, strength of recommendation, and quality of evidence was measured. Results: Ten questions were addressed. The modified CORE process and IOM-adherent process yielded concordant recommendations for 9 of 10 (90%) questions (ĸ-agreement, 0.84; 95% confidence interval, 0.55-1.00). The strength of the recommendations was the same for seven of eight (88%) graded recommendations (ĸ-agreement, 0.75; 95% confidence interval, 0.31-1.00), but ratings of the quality of evidence were discordant. The modified CORE process was less expensive and required less time and effort than the IOM-adherent process. Conclusions: The modified CORE process developed recommendations that were concordant with those developed by an experienced guideline panel using the robust standards of the IOM; however, it was less expensive and less burdensome.