The Development and Usability of the AMPREDICT Decision Support Tool: A Mixed Methods Study.
The Development and Usability of the AMPREDICT Decision Support Tool: A Mixed Methods Study.
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DOI：
10.1016/j.ejvs.2021.03.031
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Czerniecki JM
中科院分区：
文献类型：
--
作者：
Norvell DC;Suckow BD;Webster JB;Landry G;Henderson AW;Twine CP;Robbins JM;Czerniecki JM
慢性肢体威胁性缺血患者截肢水平的决策是具有挑战性的。目前，证据依赖于公布的平均人群风险，而不是个体患者风险。其结果是截肢水平在卫生系统、地理区域和时间分布上存在显著差异。临床决策支持已被证明可以提高决策能力，特别是复杂的决策。本研究的目的是通过开发和测试AMPREDICT决策支持工具（DST）的可用性来翻译先前验证的AMPREDICT预测模型，AMPREDICT决策支持工具（DST）是一种新颖的、基于网络的临床DST，计算个体术后一年的死亡风险、再截肢风险和实现截肢水平独立活动的概率。采用混合方法。先前验证的预测模型被翻译成基于web的DST，并由专家小组开发额外的内容和格式。工具可用性评估使用研究后系统可用性问卷（PSSUQ； 16项量表，得分范围从1到7，分数越低表明可用性越好），由来自不同专业、性别、地理位置和临床经验的10名临床医生最终用户进行。大声思考、半结构化、定性访谈评估了AMPREDICT DST的外观、用户友好性、可读性、功能和潜在的实现挑战。PSSUQ总分和子量表得分均较好，平均总分为1.57（标准差[SD] 0.69），范围为1.00至3.21。DST的潜在临床应用包括(1)帮助患者就截肢水平的决定提供咨询，(2)设定结果预期，以及(3)在学术环境中用作工具，以促进对导致各种结果风险的因素的理解。经过广泛的迭代开发和测试，发现AMPREDICT DST具有很强的可用性特征和临床相关性。进一步的评估将受益于将其纳入电子健康记录，并评估其对医生和患者共同截肢水平决策的影响。
Amputation level decision making in patients with chronic limb threatening ischaemia is challenging. Currently, evidence relies on published average population risks rather than individual patient risks. The result is significant variation in the distribution of amputation levels across health systems, geographical regions, and time. Clinical decision support has been shown to enhance decision making, especially complex decision making. The goal of this study was to translate the previously validated AMPREDICT prediction models by developing and testing the usability of the AMPREDICT Decision Support Tool (DST), a novel, web based, clinical DST that calculates individual one year post-operative risk of death, re-amputation, and probability of achieving independent mobility by amputation level. A mixed methods approach was used. Previously validated prediction models were translated into a web based DST with additional content and format developed by an expert panel. Tool usability was assessed using the Post-Study System Usability Questionnaire (PSSUQ; a 16 item scale with scores ranging from 1 to 7, where lower scores indicate greater usability) by 10 clinician end users from diverse specialties, sex, geography, and clinical experience. Think aloud, semi-structured, qualitative interviews evaluated the AMPREDICT DST’s look and feel, user friendliness, readability, functionality, and potential implementation challenges. The PSSUQ overall and subscale scores were favourable, with a mean overall total score of 1.57 (standard deviation [SD] 0.69) and a range from 1.00 to 3.21. The potential clinical utility of the DST included (1) assistance in counselling patients on amputation level decisions, (2) setting outcome expectations, and (3) use as a tool in the academic environment to facilitate understanding of factors that contribute to various outcome risks. After extensive iterative development and testing, the AMPREDICT DST was found to demonstrate strong usability characteristics and clinical relevance. Further evaluation will benefit from integration into an electronic health record with assessment of its impact on physician and patient shared amputation level decision making.
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