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The Development and Usability of the AMPREDICT Decision Support Tool: A Mixed Methods Study.

Daniel C Norvell1, Bjoern D Suckow2, Joseph B Webster3

  • 1VA Puget Sound Health Care System, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States; VA Centre for Limb Loss and Mobility (CLiMB), Seattle, WA, USA.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|June 5, 2021
PubMed
Summary

The AMPREDICT Decision Support Tool (DST) offers personalized risk assessment for amputation level decisions in chronic limb-threatening ischemia. This web-based tool demonstrates strong usability and clinical relevance for improving patient care and outcomes.

Keywords:
AmputationsClinical decision support systemsClinical decision support toolsDecision supportOutcomes

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Area of Science:

  • Vascular Surgery
  • Clinical Decision Support Systems
  • Health Informatics

Background:

  • Amputation level decisions for chronic limb-threatening ischemia (CLTI) are complex, often relying on generalized population risks rather than individual patient data.
  • This leads to significant variability in amputation levels across healthcare systems and geographical regions.
  • Clinical decision support tools have proven effective in enhancing complex decision-making processes.

Purpose of the Study:

  • To translate validated AMPREDICT prediction models into a user-friendly, web-based clinical decision support tool (DST).
  • To assess the usability and clinical relevance of the AMPREDICT DST for individualizing amputation level decisions.
  • To provide clinicians with a tool for calculating one-year post-operative risks (death, re-amputation) and mobility outcomes.

Main Methods:

  • A mixed-methods approach was employed, translating existing prediction models into a web-based DST.
  • Usability was evaluated by 10 diverse clinician end-users using the Post-Study System Usability Questionnaire (PSSUQ).
  • Qualitative semi-structured interviews and think-aloud protocols assessed user-friendliness, readability, functionality, and implementation challenges.

Main Results:

  • The AMPREDICT DST demonstrated favorable usability, with a mean overall PSSUQ score of 1.57 (SD 0.69).
  • Scores ranged from 1.00 to 3.21, indicating high user acceptance.
  • Potential clinical utility includes enhanced patient counseling, setting realistic outcome expectations, and academic use for understanding risk factors.

Conclusions:

  • The AMPREDICT DST exhibits strong usability and clinical relevance after iterative development and testing.
  • The tool aids in personalized amputation level decision-making for patients with CLTI.
  • Future research should focus on electronic health record integration and evaluating its impact on shared decision-making.