Development and Usability Testing of LT-CHEC: A Clinical Decision Support Tool to Improve Liver Transplant Referral in Community Gastroenterology

Background Despite clear benefits of timely liver transplantation (LT), many eligible patients are not referred. Referral challenges are common across practice settings and may be especially pronounced in community gastroenterology, where time constraints and evolving transplant policies complicate decision-making. Methods We conducted a three-phase, multicenter study: (1) needs assessment among 35 gastroenterology providers across academic and community settings using clinical vignettes and a survey; (2) development of a triage algorithm via expert consensus; and (3) usability testing of the resulting web-based clinical decision support tool, LT-CHEC, among 11 community providers from eight practices. Participants applied LT-CHEC to three vignettes and completed post-use surveys and interviews. Usability was rated on a − 3 to + 3 Likert scale. Results Knowledge and process gaps were common: 56% reported unclear referral processes, 53% were uncertain about alcohol-related eligibility. Participants rated LT-CHEC as easy to use (x̄=2.5), non-complex (x̄ =–2.1), and not requiring technical support (x̄=–2.6). Most would use it in practice (x̄=2.1) and noted moderate decision impact (x̄=1.5). Referral accuracy using the tool was 100%. Interviews emphasized clarity, logic, and the need for EHR integration. Conclusion LT-CHEC was usable and well-received across community sites, with potential to support consistent, guideline-concordant LT referral.