# frozen_string_literal: true module MalawiHivProgramReports module Cohort class Outcomes include MalawiHivProgramReports::Adapters::Moh::Custom include MalawiHivProgramReports::Utils::ModelUtils attr_reader :end_date def initialize(end_date:, definition: 'moh', location: nil) definition = definition.downcase raise ::ArgumentError, "Invalid outcomes definition: #{definition}" unless %w[moh pepfar].include?(definition) @adapter = ActiveRecord::Base.connection.adapter_name.downcase @end_date = end_date.to_date @definition = definition @location = location end def update_cummulative_outcomes initialize_table # HIC SUNT DRACONIS: The order of the operations below matters, # do not change it unless you know what you are doing!!! load_patients_who_died load_patients_who_stopped_treatment load_patients_on_pre_art load_patients_without_state load_patients_without_drug_orders load_patients_on_treatment load_defaulters end private def arv_drugs_concept_set @arv_drugs_concept_set ||= ::ConceptSet.where(set: concept_name('Antiretroviral drugs').concept) .select(:concept_id) end def drug_order_type @drug_order_type ||= order_type('Drug order') end def program_states(*names) ::ProgramWorkflowState.joins(:program_workflow) .joins(:concept) .merge(::ProgramWorkflow.where(program: hiv_program)) .merge(::Concept.joins(:concept_names) .merge(::ConceptName.where(name: names))) .select(:program_workflow_state_id) end def hiv_program @hiv_program ||= program('HIV Program') end def initialize_table ActiveRecord::Base.connection.execute <<~SQL DROP TABLE IF EXISTS temp_patient_outcomes SQL ActiveRecord::Base.connection.execute <<~SQL CREATE TABLE temp_patient_outcomes ( patient_id INT NOT NULL, cum_outcome VARCHAR(120) NOT NULL, outcome_date DATE DEFAULT NULL, site_id INT NOT NULL, PRIMARY KEY (patient_id, site_id) ) SQL ActiveRecord::Base.connection.execute <<~SQL CREATE INDEX tpo_outcomes ON temp_patient_outcomes (patient_id, cum_outcome, outcome_date, site_id) SQL end # Loads all patiens with an outcome of died as of given date # into the temp_patient_outcomes table. def load_patients_who_died date = ActiveRecord::Base.connection.quote(end_date) ActiveRecord::Base.connection.execute <<~SQL INSERT INTO temp_patient_outcomes SELECT patients.patient_id, 'Patient died', patient_state.start_date, #{@location} FROM temp_earliest_start_date AS patients INNER JOIN patient_program ON patient_program.patient_id = patients.patient_id AND patient_program.program_id = #{hiv_program.program_id} AND patient_program.voided = 0 #{site_manager(operator: 'AND', column: 'patient_program.site_id', location: @location)} INNER JOIN patient_state ON patient_state.patient_program_id = patient_program.patient_program_id AND patient_state.state = (#{program_states('Patient died').limit(1).to_sql}) AND patient_state.start_date < #{interval_manager(date:, value: 1, interval: 'DAY', operator: '+')} AND patient_state.voided = 0 #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} WHERE patients.date_enrolled <= #{date} #{site_manager(operator: 'AND', column: 'patients.site_id', location: @location)} AND patient_state.date_created = (SELECT MAX(date_created) FROM patient_state ps WHERE ps.patient_program_id = patient_state.patient_program_id #{site_manager(operator: 'AND', column: 'ps.site_id', location: @location)} AND ps.state = patient_state.state AND ps.voided = 0 AND ps.start_date <= #{date}) GROUP BY patients.patient_id SQL end # Loads all patients with an outcome of transferred out or # treatment stopped into temp_patient_outcomes table. def load_patients_who_stopped_treatment date = ActiveRecord::Base.connection.quote(end_date) ActiveRecord::Base.connection.execute <<~SQL INSERT INTO temp_patient_outcomes SELECT patients.patient_id, ( SELECT name FROM concept_name WHERE concept_id = ( SELECT concept_id FROM program_workflow_state WHERE program_workflow_state_id = patient_state.state LIMIT 1 ) ) AS cum_outcome, patient_state.start_date, #{@location} FROM temp_earliest_start_date AS patients INNER JOIN patient_program ON patient_program.patient_id = patients.patient_id AND patient_program.program_id = #{hiv_program.program_id} AND patient_program.voided = 0 #{site_manager(operator: 'AND', column: 'patient_program.site_id', location: @location)} INNER JOIN patient_state ON patient_state.patient_program_id = patient_program.patient_program_id AND patient_state.state IN (#{program_states('Patient transferred out', 'Treatment stopped').to_sql}) AND patient_state.start_date < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')} AND (patient_state.end_date >= #{date} OR patient_state.end_date IS NULL) AND patient_state.voided = 0 #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} INNER JOIN ( SELECT patient_program_id, MAX(start_date) AS start_date FROM patient_state WHERE patient_state.start_date < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')} AND patient_state.voided = 0 #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} GROUP BY patient_program_id ) AS max_patient_state ON max_patient_state.patient_program_id = patient_state.patient_program_id AND max_patient_state.start_date = patient_state.start_date #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} WHERE patients.date_enrolled <= #{date} #{site_manager(operator: 'AND', column: 'patients.site_id', location: @location)} AND patients.patient_id NOT IN (SELECT patient_id FROM temp_patient_outcomes #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)} ) GROUP BY patients.patient_id #{@adapter == 'mysql2' ? '' : ',patient_state.state, patient_state.start_date'} SQL end # Load all patients on Pre-ART. def load_patients_on_pre_art date = ActiveRecord::Base.connection.quote(end_date) ActiveRecord::Base.connection.execute <<~SQL INSERT INTO temp_patient_outcomes SELECT patients.patient_id, CASE WHEN #{current_defaulter_function('patients.patient_id')} = 1 THEN 'Defaulted' ELSE 'Pre-ART (Continue)' END AS cum_outcome, patient_state.start_date, #{@location} FROM temp_earliest_start_date AS patients INNER JOIN patient_program ON patient_program.patient_id = patients.patient_id AND patient_program.program_id = #{hiv_program.program_id} AND patient_program.voided = 0 #{site_manager(operator: 'AND', column: 'patient_program.site_id', location: @location)} INNER JOIN patient_state ON patient_state.patient_program_id = patient_program.patient_program_id AND patient_state.state = (#{program_states('Pre-ART (Continue)').limit(1).to_sql}) AND patient_state.start_date < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')} AND (patient_state.end_date >= #{date} OR patient_state.end_date IS NULL) AND patient_state.voided = 0 #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} INNER JOIN ( SELECT patient_program_id, MAX(start_date) AS start_date FROM patient_state WHERE patient_state.start_date < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')} AND patient_state.voided = 0 #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} GROUP BY patient_program_id ) AS max_patient_state ON max_patient_state.patient_program_id = patient_state.patient_program_id AND max_patient_state.start_date = patient_state.start_date #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} WHERE patients.date_enrolled <= #{date} #{site_manager(operator: 'AND', column: 'patients.site_id', location: @location)} AND patients.patient_id NOT IN (SELECT patient_id FROM temp_patient_outcomes #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)} ) GROUP BY patients.patient_id #{@adapter == 'mysql2' ? '' : ',patient_state.start_date'} SQL end # Load all patients without a state def load_patients_without_state date = ActiveRecord::Base.connection.quote(end_date) ActiveRecord::Base.connection.execute <<~SQL INSERT INTO temp_patient_outcomes SELECT patients.patient_id, CASE WHEN #{current_defaulter_function('patients.patient_id')} = 1 THEN 'Defaulted' ELSE 'Unknown' END AS cum_outcome, NULL, #{@location} as site_id FROM temp_earliest_start_date AS patients INNER JOIN patient_program ON patient_program.patient_id = patients.patient_id AND patient_program.program_id = #{hiv_program.program_id} AND patient_program.voided = 0 #{site_manager(operator: 'AND', column: 'patient_program.site_id', location: @location)} WHERE patients.date_enrolled <= #{date} AND patient_program.patient_program_id NOT IN ( SELECT patient_program_id FROM patient_state WHERE start_date < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')} AND voided = 0 #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} ) AND patients.patient_id NOT IN (SELECT patient_id FROM temp_patient_outcomes #{site_manager(operator: 'WHERE', column: 'patient_program.site_id', location: @location)} ) GROUP BY patients.patient_id SQL end # Load all patients without drug orders or have drug orders # without a quantity. def load_patients_without_drug_orders date = ActiveRecord::Base.connection.quote(end_date) ActiveRecord::Base.connection.execute <<~SQL INSERT INTO temp_patient_outcomes SELECT patients.patient_id, 'Unknown', NULL, #{@location} FROM temp_earliest_start_date AS patients WHERE date_enrolled <= #{date} #{site_manager(operator: 'AND', column: 'patients.site_id', location: @location)} AND patient_id NOT IN (SELECT patient_id FROM temp_patient_outcomes #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)} ) AND patient_id NOT IN ( SELECT patient_id FROM orders LEFT JOIN drug_order ON orders.order_id = drug_order.order_id #{site_manager(operator: 'AND', column: 'drug_order.site_id', location: @location)} WHERE start_date < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')} AND quantity > 0 #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)} AND order_type_id = #{drug_order_type.order_type_id} AND concept_id IN (#{arv_drugs_concept_set.to_sql}) ) SQL end # Loads all patients who are on treatment def load_patients_on_treatment date = ActiveRecord::Base.connection.quote(end_date) ActiveRecord::Base.connection.execute <<~SQL INSERT INTO temp_patient_outcomes SELECT patients.patient_id, 'On antiretrovirals', patient_state.start_date, #{@location} FROM temp_earliest_start_date AS patients INNER JOIN patient_program ON patient_program.patient_id = patients.patient_id AND patient_program.program_id = #{hiv_program.program_id} AND patient_program.voided = 0 #{site_manager(operator: 'AND', column: 'patient_program.site_id', location: @location)} /* Get patients' `on ARV` states that are before given date */ INNER JOIN patient_state ON patient_state.patient_program_id = patient_program.patient_program_id AND patient_state.state = (#{program_states('On antiretrovirals').limit(1).to_sql}) AND patient_state.start_date < #{interval_manager(date:, value: 1, interval: 'DAY', operator: '+')} AND (patient_state.end_date >= #{date} OR patient_state.end_date IS NULL) AND patient_state.voided = 0 #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} /* Select only the most recent state out of those retrieved above */ INNER JOIN ( SELECT patient_program_id, MAX(start_date) AS start_date FROM patient_state WHERE patient_state.start_date < #{interval_manager(date:, value: 1, interval: 'DAY', operator: '+')} AND patient_state.voided = 0 #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} GROUP BY patient_program_id ) AS max_patient_state ON max_patient_state.patient_program_id = patient_state.patient_program_id AND max_patient_state.start_date = patient_state.start_date #{site_manager(operator: 'AND', column: 'patient_state.site_id', location: @location)} /* HACK: Ensure that the states captured above do correspond have corresponding ARV dispensations. In other words filter out any `on ARVs` states whose dispensation's may have been voided or states that were created manually without any drugs being dispensed. */ INNER JOIN ( SELECT orders.patient_id, MIN(orders.auto_expire_date) AS auto_expire_date FROM orders INNER JOIN drug_order ON orders.order_id = drug_order.order_id #{site_manager(operator: 'AND', column: 'drug_order.site_id', location: @location)} INNER JOIN ( SELECT patient_id, MAX(start_date) AS start_date FROM orders INNER JOIN drug_order ON orders.order_id = drug_order.order_id #{site_manager(operator: 'AND', column: 'drug_order.site_id', location: @location)} AND drug_order.quantity > 0 WHERE order_type_id = #{drug_order_type.order_type_id} AND concept_id IN (#{arv_drugs_concept_set.to_sql}) AND orders.start_date < #{interval_manager(date:, value: 1, interval: 'DAY', operator: '+')} AND voided = 0 #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)} AND patient_id IN (SELECT patient_id FROM temp_earliest_start_date #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)} ) AND patient_id NOT IN (SELECT patient_id FROM temp_patient_outcomes #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)} ) GROUP BY patient_id ) AS max_drug_orders ON max_drug_orders.patient_id = orders.patient_id AND max_drug_orders.start_date = orders.start_date #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)} WHERE order_type_id = #{drug_order_type.order_type_id} AND concept_id IN (#{arv_drugs_concept_set.to_sql}) AND orders.start_date < #{interval_manager(date:, value: 1, interval: 'DAY', operator: '+')} AND quantity > 0 AND voided = 0 #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)} AND orders.patient_id IN (SELECT patient_id FROM temp_earliest_start_date #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)}) AND orders.patient_id NOT IN (SELECT patient_id FROM temp_patient_outcomes #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)}) GROUP BY orders.patient_id ) AS first_order_to_expire ON (first_order_to_expire.auto_expire_date >= #{date} OR #{timestampdiff_manager(date1: 'DATE(first_order_to_expire.auto_expire_date)', date2: date, interval: 'DAY')} <= #{@definition == 'pepfar' ? 28 : 56}) AND first_order_to_expire.patient_id = patient_program.patient_id #{site_manager(operator: 'AND', column: 'patient_program.site_id', location: @location)} WHERE patients.date_enrolled <= #{date} #{site_manager(operator: 'AND', column: 'patients.site_id', location: @location)} AND patients.patient_id NOT IN (SELECT patient_id FROM temp_patient_outcomes #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)} ) GROUP BY patients.patient_id #{@adapter == 'mysql2' ? '' : ',patient_state.start_date'} SQL end # Load defaulters def load_defaulters date = ActiveRecord::Base.connection.quote(end_date) ActiveRecord::Base.connection.execute <<~SQL INSERT INTO temp_patient_outcomes SELECT patient_id, #{patient_outcome_function('patient_id')}, NULL, #{@location} FROM temp_earliest_start_date WHERE date_enrolled <= #{date} #{site_manager(operator: 'AND', column: 'site_id', location: @location)} AND patient_id NOT IN (SELECT patient_id FROM temp_patient_outcomes #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)} ) SQL end def current_defaulter_function(sql_column) defaulter_function = @definition == 'moh' ? 'current_defaulter' : 'current_pepfar_defaulter' quoted_end_date = ActiveRecord::Base.connection.quote(end_date) parameters = "#{sql_column}, #{quoted_end_date}, #{@location}" function_manager(function: defaulter_function, location: @location, args: parameters) rescue StandardError => e Rails.logger.error "Error: #{e.message}" raise "Invalid outcomes definition: #{@definition}" end def patient_outcome_function(sql_column) outcome_function = @definition == 'moh' ? 'patient_outcome' : 'pepfar_patient_outcome' quoted_end_date = ActiveRecord::Base.connection.quote(end_date) parameters = "#{sql_column}, #{quoted_end_date}, #{@location}" function_manager(function: outcome_function, location: @location, args: parameters) rescue StandardError => e Rails.logger.error "Error: #{e.message}" raise "Invalid outcomes definition: #{@definition}" end end end end