The Development and Usability of the AMPREDICT Decision Support Tool: A mixed methods study

Daniel Norvell*, Bjoern Suckow, Joseph Webster, Gregory Landry, Alison Henderson, Chris P Twine, Jeffrey Robbins, Joseph Czerniecki

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
14 Downloads (Pure)


Objectives: Amputation level decision making in patients with chronic limb threatening ischemia is challenging. Currently, evidence relies on published average population risks rather than individual patient risks. The result, significant variation in 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 1-year postoperative risk of mortality, reamputation, and probability of achieving independent mobility by amputation level.
Design: Mixed methods.
Materials: Previously validated prediction models were translated into a web-based DST with additional content and format developed by an expert panel. Usability of the tool was assessed using the Post-Study System Usability Questionnaire (PSSUQ; a 16-item scale with scores ranging from 1-7, where lower scores indicate greater usability) by 10 clinician end users from diverse specialties, sex, geography, and clinical experience.
Methods: Think-aloud, semi-structured, qualitative interviews evaluated the AMPREDICT DST’s look and feel, user-friendliness, readability, functionality, and potential implementation challenges.
Results: The PSSUQ overall and subscale scores were favorable, with a mean overall total score of 1.57 (SD=.69) and a range from 1.00-3.21. The potential clinical utility of the DST included: (1) assistance in counseling 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.
Conclusion: 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.
Original languageEnglish
Pages (from-to)304-311
JournalEuropean Journal of Vascular and Endovascular Surgery
Issue number2
Early online date1 Jun 2021
Publication statusPublished - 1 Aug 2021


  • Decision support
  • clinical decision support tools
  • clinical decision support systems
  • amputations
  • outcomes


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