Applies to stratifiers (#307)

* appliesTo stratifier functionality

* Remove DetailedResults changes, add comments

* Clean up comments

* Only add id and/or code on MeasureReport if they exist

* Additional unit tests

* Unit test for summary MeasureReport

* Remove unnecessary check

src/calculation/DetailedResultsBuilder.ts

@@ -306,7 +306,7 @@ export function createPatientPopulationValues(
  const value = patientResults[strata.criteria?.expression];
  const result = isStatementValueTruthy(value);
  stratifierResults?.push({
- strataCode: strata.code?.text ?? `strata-${strataIndex++}`,
+ strataCode: strata.code?.text ?? strata.id ?? `strata-${strataIndex++}`,
  result,
  ...(strata.id ? { strataId: strata.id } : {})
  });

src/calculation/MeasureReportBuilder.ts

@@ -9,6 +9,7 @@ import {
 import { UnexpectedProperty, UnsupportedProperty } from '../types/errors/CustomErrors';
 import { isDetailedResult } from '../helpers/DetailedResultsHelpers';
 import { AbstractMeasureReportBuilder } from './AbstractMeasureReportBuilder';
+import { MeasureReportGroupStratifier } from 'fhir/r4';
 
 export default class MeasureReportBuilder<T extends PopulationGroupResult> extends AbstractMeasureReportBuilder<T> {
  report: fhir4.MeasureReport;
@@ -130,13 +131,32 @@ export default class MeasureReportBuilder<T extends PopulationGroupResult> exten
  group.stratifier = [];
  measureGroup.stratifier.forEach(s => {
  const reportStratifier = <fhir4.MeasureReportGroupStratifier>{};
- reportStratifier.code = s.code ? [s.code] : [];
+ if (s.code) {
+ reportStratifier.code = [s.code];
+ }
+ if (s.id) {
+ reportStratifier.id = s.id;
+ }
  const strat = <fhir4.MeasureReportGroupStratifierStratum>{};
  // use existing populations, but reduce count as appropriate
  // Deep copy population with matching attributes but different interface
- strat.population = <fhir4.MeasureReportGroupStratifierStratumPopulation[]>(
- JSON.parse(JSON.stringify(group.population))
+ // if a stratifier has a cqfm-appliesTo extension, then we only want to
+ // include that population. If none is specified, the stratification applies
+ // to all populations in a group
+ const appliesToExtension = s.extension?.find(
+ e => e.url === 'http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo'
  );
+ if (appliesToExtension) {
+ const popCode = appliesToExtension.valueCodeableConcept?.coding?.[0].code;
+ const matchingPop = group.population?.find(p => p.code?.coding?.[0].code === popCode);
+ strat.population = <fhir4.MeasureReportGroupStratifierStratumPopulation[]>(
+ JSON.parse(JSON.stringify([matchingPop]))
+ );
+ } else {
+ strat.population = <fhir4.MeasureReportGroupStratifierStratumPopulation[]>(
+ JSON.parse(JSON.stringify(group.population))
+ );
+ }
 
  reportStratifier.stratum = [strat];
  group.stratifier?.push(reportStratifier);
@@ -217,7 +237,11 @@ export default class MeasureReportBuilder<T extends PopulationGroupResult> exten
  er.stratifierResults?.forEach(stratResults => {
  // only add to results if this episode is in the strata
  if (stratResults.result) {
- const strata = group.stratifier?.find(s => s.code && s.code[0].text === stratResults.strataCode);
+ // the strataCode has the potential to be a couple of things, either s.code[0].text (previous measures)
+ // or s.id (newer measures)
+ const strata: MeasureReportGroupStratifier | undefined =
+ group.stratifier?.find(s => s.code && s.code[0]?.text === stratResults.strataCode) ||
+ group.stratifier?.find(s => s.id === stratResults.strataCode);
  const stratum = strata?.stratum?.[0];
  if (stratum) {
  er.populationResults?.forEach(pr => {
@@ -255,7 +279,11 @@ export default class MeasureReportBuilder<T extends PopulationGroupResult> exten
  groupResults.stratifierResults?.forEach(stratResults => {
  // only add to results if this patient is in the strata
  if (stratResults.result) {
- const strata = group.stratifier?.find(s => s.code && s.code[0].text === stratResults.strataCode);
+ // the strataCode has the potential to be a couple of things, either s.code[0].text (previous measures)
+ // or s.id (newer measures)
+ const strata: MeasureReportGroupStratifier | undefined =
+ group.stratifier?.find(s => s.code && s.code[0]?.text === stratResults.strataCode) ||
+ group.stratifier?.find(s => s.id === stratResults.strataCode);
  const stratum = strata?.stratum?.[0];
  if (stratum) {
  groupResults.populationResults?.forEach(pr => {
@@ -318,10 +346,6 @@ export default class MeasureReportBuilder<T extends PopulationGroupResult> exten
  // add to pop count creating it if not already created.
  if (!pop.count) pop.count = 0;
  pop.count += pr.result ? 1 : 0;
- } else {
- throw new UnexpectedProperty(
- `Population ${pr.populationType} in stratum ${stratum.id} not found in measure report.`
- );
  }
  }
  }

test/unit/MeasureReportBuilder.test.ts

@@ -3,7 +3,12 @@
 import { PatientSource } from 'cql-exec-fhir';
 import MeasureReportBuilder from '../../src/calculation/MeasureReportBuilder';
 import { getJSONFixture } from './helpers/testHelpers';
-import { ExecutionResult, CalculationOptions, DetailedPopulationGroupResult } from '../../src/types/Calculator';
+import {
+ ExecutionResult,
+ CalculationOptions,
+ DetailedPopulationGroupResult,
+ PopulationGroupResult
+} from '../../src/types/Calculator';
 import { PopulationType } from '../../src/types/Enums';
 
 const patient1 = getJSONFixture(
@@ -20,6 +25,7 @@ const patient1Id = '3413754c-73f0-4559-9f67-df8e593ce7e1';
 const patient2Id = '08fc9439-b7ff-4309-b409-4d143388594c';
 
 const simpleMeasure = getJSONFixture('measure/simple-measure.json') as fhir4.Measure;
+const propWithStratMeasure = getJSONFixture('measure/proportion-measure-with-stratifiers.json') as fhir4.Measure;
 const ratioMeasure = getJSONFixture('measure/ratio-measure.json') as fhir4.Measure;
 const cvMeasure = getJSONFixture('measure/cv-measure.json') as fhir4.Measure;
 const cvMeasureScoringOnGroup = getJSONFixture('measure/group-score-cv-measure.json');
@@ -36,6 +42,7 @@ function buildTestMeasureBundle(measure: fhir4.Measure): fhir4.Bundle {
  };
 }
 const simpleMeasureBundle = buildTestMeasureBundle(simpleMeasure);
+const propWithStratMeasureBundle = buildTestMeasureBundle(propWithStratMeasure);
 const ratioMeasureBundle = buildTestMeasureBundle(ratioMeasure);
 const cvMeasureBundle = buildTestMeasureBundle(cvMeasure);
 
@@ -225,6 +232,63 @@ const cvExecutionResults: ExecutionResult<DetailedPopulationGroupResult>[] = [
  }
 ];
 
+const propWithStratExecutionResults: ExecutionResult<DetailedPopulationGroupResult>[] = [
+ {
+ patientId: patient1Id,
+ detailedResults: [
+ {
+ groupId: 'group-1',
+ statementResults: [],
+ populationResults: [
+ {
+ populationType: PopulationType.NUMER,
+ criteriaExpression: 'Numerator',
+ result: false
+ },
+ {
+ populationType: PopulationType.DENOM,
+ criteriaExpression: 'Denominator',
+ result: true
+ },
+ {
+ populationType: PopulationType.IPP,
+ criteriaExpression: 'Initial Population',
+ result: true
+ },
+ {
+ populationType: PopulationType.DENEX,
+ criteriaExpression: 'Denominator Exclusion',
+ result: false
+ }
+ ],
+ stratifierResults: [
+ {
+ strataCode: '93f5f1c7-8638-40a4-a596-8b5831599209',
+ result: false,
+ strataId: '93f5f1c7-8638-40a4-a596-8b5831599209'
+ },
+ {
+ strataCode: '5baf37c7-8887-4576-837e-ea20a8938282',
+ result: false,
+ strataId: '5baf37c7-8887-4576-837e-ea20a8938282'
+ },
+ {
+ strataCode: '125b3d95-2d00-455f-8a6e-d53614a2a50e',
+ result: false,
+ strataId: '125b3d95-2d00-455f-8a6e-d53614a2a50e'
+ },
+ {
+ strataCode: 'c06647b9-e134-4189-858d-80cee23c0f8d',
+ result: false,
+ strataId: 'c06647b9-e134-4189-858d-80cee23c0f8d'
+ }
+ ],
+ html: 'example-html'
+ }
+ ]
+ }
+];
+
 const calculationOptions: CalculationOptions = {
  measurementPeriodStart: '2021-01-01',
  measurementPeriodEnd: '2021-12-31',
@@ -316,6 +380,108 @@ describe('MeasureReportBuilder Static', () => {
  });
  });
 
+ describe('Measure Report from Proportion Measure with stratifiers', () => {
+ let measureReports: fhir4.MeasureReport[];
+ beforeAll(() => {
+ measureReports = MeasureReportBuilder.buildMeasureReports(
+ propWithStratMeasureBundle,
+ propWithStratExecutionResults,
+ calculationOptions
+ );
+ });
+
+ test('should generate 1 result', () => {
+ expect(measureReports).toBeDefined();
+ expect(measureReports).toHaveLength(1);
+ });
+
+ test('should contain proper stratifierResults', () => {
+ const [mr] = measureReports;
+
+ expect(mr.group).toBeDefined();
+ expect(mr.group).toHaveLength(1);
+
+ const [group] = mr.group!;
+ const result = propWithStratExecutionResults[0].detailedResults?.[0];
+
+ expect(group.id).toEqual(result!.groupId);
+ expect(group.measureScore).toBeDefined();
+ expect(group.population).toBeDefined();
+
+ result!.populationResults!.forEach(pr => {
+ const populationResult = group.population?.find(p => p.code?.coding?.[0].code === pr.populationType);
+ expect(populationResult).toBeDefined();
+ expect(populationResult!.count).toEqual(pr.result === true ? 1 : 0);
+ });
+
+ result!.stratifierResults!.forEach(sr => {
+ const stratifierResult = group.stratifier?.find(s => s.id === sr.strataId);
+ expect(stratifierResult).toBeDefined();
+ expect(stratifierResult!.stratum?.[0].population?.length).toEqual(1);
+ expect(stratifierResult!.stratum?.[0].measureScore?.value).toEqual(0);
+ });
+ });
+ });
+
+ describe('Measure Report from Proportion Measure with stratifiers and two patient results', () => {
+ let builder: MeasureReportBuilder<PopulationGroupResult>;
+ beforeAll(() => {
+ builder = new MeasureReportBuilder(propWithStratMeasure, {
+ reportType: 'summary',
+ measurementPeriodStart: '2021-01-01',
+ measurementPeriodEnd: '2021-12-31'
+ });
+
+ builder.addPatientResults({
+ patientId: patient1Id,
+ detailedResults: [
+ {
+ groupId: 'group-1',
+ stratifierResults: [
+ {
+ strataCode: '93f5f1c7-8638-40a4-a596-8b5831599209',
+ result: false,
+ strataId: '93f5f1c7-8638-40a4-a596-8b5831599209'
+ },
+ {
+ strataCode: '5baf37c7-8887-4576-837e-ea20a8938282',
+ result: false,
+ strataId: '5baf37c7-8887-4576-837e-ea20a8938282'
+ }
+ ]
+ }
+ ]
+ });
+
+ builder.addPatientResults({
+ patientId: patient2Id,
+ detailedResults: [
+ {
+ groupId: 'group-1',
+ stratifierResults: [
+ {
+ strataCode: '125b3d95-2d00-455f-8a6e-d53614a2a50e',
+ result: false,
+ strataId: '125b3d95-2d00-455f-8a6e-d53614a2a50e'
+ },
+ {
+ strataCode: 'c06647b9-e134-4189-858d-80cee23c0f8d',
+ result: false,
+ strataId: 'c06647b9-e134-4189-858d-80cee23c0f8d'
+ }
+ ]
+ }
+ ]
+ });
+ });
+
+ test('should generate a summary MeasureReport whose stratifierResults only contain one population in the stratum', () => {
+ const { report } = builder;
+ expect(report).toBeDefined();
+ expect(report.group?.[0].stratifier?.[0].stratum?.[0].population?.length).toEqual(1);
+ });
+ });
+
  describe('Ratio Measure Report', () => {
  let measureReports: fhir4.MeasureReport[];
  beforeAll(() => {