{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T05:40:16Z","timestamp":1768628416885,"version":"3.49.0"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100006400","name":"Alnylam Pharmaceuticals","doi-asserted-by":"publisher","award":["Investigator-initiated Research"],"award-info":[{"award-number":["Investigator-initiated Research"]}],"id":[{"id":"10.13039\/100006400","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Heart failure is a clinical syndrome resulting from numerous pathological conditions. One cause of heart failure, transthyretin cardiac amyloidosis, presents insidiously with common and seemingly unrelated symptoms. New treatments for cardiac amyloidosis are available that extend and improve life. However, providers are not testing patients for transthyretin cardiac amyloidosis. We took a systems science approach to explore the system of care for transthyretin cardiac amyloidosis testing by depicting the healthcare system from patient presentation to treatment. Our goal was to define an ideal healthcare system to improve the uptake of testing protocols and enhance patient outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We assembled clinicians, researchers, and patients to participate in a co-design workshop using the first step of System Evaluation Theory to define an ideal testing and diagnostic protocol using transthyretin cardiac amyloidosis as a case study. We tasked workshop attendees with defining the patient and clinician journey from symptom presentation to diagnosis. We generated a system map using a qualitative matrix analysis of a transcript of the workshop discussion.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The matrix analysis organized input from all stakeholders, allowing for the creation of a system map that reveals the complexity of the transthyretin cardiac amyloidosis testing process and potential implementation strategies to improve the efficiency and effectiveness of the system. This methodology successfully yielded generalizable elements of a testing protocol and testable strategies to facilitate the implementation of a protocol adapted to fit local site needs.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The substeps outlined within System Evaluation Theory Step 1 helped identify an ideal system for testing and diagnosing transthyretin cardiac amyloidosis care that could be applied to specific settings to identify, improve, and implement protocols for other complex diseases.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0339063","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T18:34:34Z","timestamp":1768588474000},"page":"e0339063","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Testing the utility of the first step of system evaluation theory in creating a system map of care for cardiac amyloidosis early detection: A case study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2362-9499","authenticated-orcid":true,"given":"Sherry L.","family":"Ball","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7678-1008","authenticated-orcid":true,"given":"Alexis","family":"Koskan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenice","family":"Guzman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandesh","family":"Dev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"issue":"3","key":"pone.0339063.ref001","first-page":"36","article-title":"Barriers and strategies in guideline implementation-a scoping review","volume":"4","author":"F Fischer","year":"2016","journal-title":"Healthc Basel Switz"},{"issue":"6","key":"pone.0339063.ref002","doi-asserted-by":"crossref","first-page":"3460","DOI":"10.1002\/nop2.1607","article-title":"Fragmented care and chronic illness patient outcomes: a systematic review","volume":"10","author":"JY Joo","year":"2023","journal-title":"Nurs Open"},{"key":"pone.0339063.ref003","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/1472-6947-8-38","article-title":"Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review","volume":"8","author":"AL Francke","year":"2008","journal-title":"BMC Med Inform Decis Mak"},{"issue":"1032","key":"pone.0339063.ref004","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1136\/pgmj.2010.116012","article-title":"Patterns of \u201cleakage\u201d in the utilisation of clinical guidelines: a systematic review","volume":"87","author":"S Mickan","year":"2011","journal-title":"Postgrad Med J"},{"key":"pone.0339063.ref005","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1108\/979-8-88730-044-3","volume-title":"System Evaluation Theory: A Blueprint for Practitioners Evaluationg Complex Interventions Operating and Functioning as Systems","author":"R Renger","year":"2022"},{"issue":"18","key":"pone.0339063.ref006","doi-asserted-by":"crossref","first-page":"3517","DOI":"10.1093\/cvr\/cvac119","article-title":"Transthyretin cardiac amyloidosis","volume":"118","author":"A Porcari","year":"2023","journal-title":"Cardiovasc Res"},{"key":"pone.0339063.ref007","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1146\/annurev-med-052918-020140","article-title":"Cardiac amyloidosis: overlooked, underappreciated, and treatable","volume":"71","author":"J Rubin","year":"2020","journal-title":"Annu Rev Med"},{"issue":"11","key":"pone.0339063.ref008","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jacc.2022.11.022","article-title":"2023 ACC Expert Consensus Decision Pathway on Comprehensive Multidisciplinary Care for the Patient With Cardiac Amyloidosis: A Report of the American College of Cardiology Solution Set Oversight Committee","volume":"81","author":"Writing Committee","year":"2023","journal-title":"J Am Coll Cardiol."},{"issue":"1","key":"pone.0339063.ref009","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s11897-025-00701-4","article-title":"Etiological treatment of cardiac amyloidosis: standard of care and future directions","volume":"22","author":"YF Ferrari Chen","year":"2025","journal-title":"Curr Heart Fail Rep"},{"key":"pone.0339063.ref010","doi-asserted-by":"crossref","unstructured":"Renger R, Renger J, Donaldson SI, Renger J, Hart G, Hawkins A. Comparing and contrasting a program versus system approach to evaluation: The example of a cardiac care system. 2020.","DOI":"10.3138\/cjpe.68127"},{"issue":"1","key":"pone.0339063.ref011","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/jan.15479","article-title":"Reporting and conducting patient journey mapping research in healthcare: a scoping review","volume":"79","author":"EL Davies","year":"2023","journal-title":"J Adv Nurs"},{"issue":"4","key":"pone.0339063.ref012","doi-asserted-by":"crossref","first-page":"100715","DOI":"10.1016\/j.hjdsi.2023.100715","article-title":"A service blueprint approach to prioritize operational improvements in a new outpatient clinic","volume":"11","author":"VM Bartch","year":"2023","journal-title":"Healthc (Amst)"},{"issue":"1","key":"pone.0339063.ref013","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1186\/s12913-021-06254-1","article-title":"Process mapping in healthcare: a systematic review","volume":"21","author":"G Antonacci","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0339063.ref014","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s13012-024-01397-1","article-title":"Planning for and Assessing Rigor in Rapid Qualitative Analysis (PARRQA): a consensus-based framework for designing, conducting, and reporting","volume":"19","author":"CP Kowalski","year":"2024","journal-title":"Implement Sci"},{"key":"pone.0339063.ref015","first-page":"1","article-title":"Matrix analysis as a complementary analytic strategy in qualitative inquiry","volume":"14","author":"JB Averill","year":"2008","journal-title":"Qual Inq"},{"issue":"9","key":"pone.0339063.ref016","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1080\/0142159X.2018.1497149","article-title":"Twelve tips for conducting qualitative research interviews","volume":"41","author":"C McGrath","year":"2019","journal-title":"Med Teach"},{"issue":"1","key":"pone.0339063.ref017","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1515\/eujal-2023-0045","article-title":"Sharing interview questions in advance: methodological considerations in applied linguistics research","volume":"12","author":"\u00c5 Hauk\u00e5s","year":"2024","journal-title":"Eur J Appl Linguist"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339063","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T18:34:40Z","timestamp":1768588480000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339063"}},"subtitle":[],"editor":[{"given":"Ian James","family":"Martins","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0339063","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]}}}