Update lab-based statin nudge threshold to 20% (#5435)

https://app.shortcut.com/simpledotorg/story/15529/fix-the-lab-based-statin-nudge

---------

Co-authored-by: Siddharth Agarwal <[email protected]>

Author: siddh1004

app/src/main/java/org/simple/clinic/cvdrisk/CVDRiskRange.kt

@@ -15,9 +15,12 @@ data class CVDRiskRange(
   val level: CVDRiskLevel
     get() = CVDRiskLevel.compute(this)
 
-  val canPrescribeStatin: Boolean
+  val canPrescribeNonLabBasedStatin: Boolean
     get() = max >= 10
 
+  val canPrescribeLabBasedStatin: Boolean
+    get() = max >= 20
+
   class RoomTypeConverter {
 
     @TypeConverter

app/src/main/java/org/simple/clinic/summary/PatientSummaryUpdate.kt

@@ -35,7 +35,7 @@ class PatientSummaryUpdate(
     private val isLabBasedStatinNudgeEnabled: Boolean,
     private val minAgeForStatin: Int = 40,
     private val maxAgeForCVDRisk: Int = 74,
-    private val minReqMaxRiskRangeForLabBasedNudge: Int = 10,
+    private val minReqMaxRiskRangeForLabBasedNudge: Int = 20,
 ) : Update<PatientSummaryModel, PatientSummaryEvent, PatientSummaryEffect> {
 
   override fun update(
@@ -319,9 +319,9 @@ class PatientSummaryUpdate(
     val bmiReading = event.bmiReading
     val calculatedRiskRange = event.riskRange
     val canPrescribeStatin = if (isLabBasedStatinNudgeEnabled) {
-      checkIfLabBasedNudgeCanBeShown(event.medicalHistory, event.riskRange)
+      calculatedRiskRange?.canPrescribeLabBasedStatin ?: false
     } else {
-      calculatedRiskRange?.canPrescribeStatin ?: false
+      calculatedRiskRange?.canPrescribeNonLabBasedStatin ?: false
     }
 
     val canShowSmokingStatusDialog = canPrescribeStatin &&
@@ -353,14 +353,6 @@ class PatientSummaryUpdate(
     }
   }
 
-  private fun checkIfLabBasedNudgeCanBeShown(
-    medicalHistory: MedicalHistory,
-    riskRange: CVDRiskRange?
-  ): Boolean {
-    val maxRiskRange = riskRange?.max ?: 0
-    return !(medicalHistory.diagnosedWithDiabetes != Yes && maxRiskRange < minReqMaxRiskRangeForLabBasedNudge)
-  }
-
   private fun labBasedRiskRange(calculatedRiskRange: CVDRiskRange?): CVDRiskRange? {
     if (calculatedRiskRange == null) return null
 

app/src/main/java/org/simple/clinic/summary/compose/StatinNudgeView.kt

@@ -96,6 +96,7 @@ fun StatinNudge(
           Spacer(modifier = Modifier.height(16.dp))
           DescriptionText(
               isLabBasedStatinNudgeEnabled = isLabBasedStatinNudgeEnabled,
+              isNonLabBasedStatinNudgeEnabled = isNonLabBasedStatinNudgeEnabled,
               statinInfo = statinInfo
           )
 
@@ -262,17 +263,22 @@ fun RiskProgressBar(
 fun DescriptionText(
     statinInfo: StatinInfo,
     isLabBasedStatinNudgeEnabled: Boolean,
+    isNonLabBasedStatinNudgeEnabled: Boolean,
 ) {
   val text = descriptionText(
       isLabBasedStatinNudgeEnabled = isLabBasedStatinNudgeEnabled,
+      isNonLabBasedStatinNudgeEnabled = isNonLabBasedStatinNudgeEnabled,
       statinInfo = statinInfo,
   )
 
   val textColor = when {
-    statinInfo.cvdRisk == null || statinInfo.cvdRisk.level == CVDRiskLevel.HIGH || statinInfo.hasDiabetes
-      -> SimpleTheme.colors.material.error
+    statinInfo.hasDiabetes || statinInfo.hasCVD -> SimpleTheme.colors.material.error
+    isLabBasedStatinNudgeEnabled && (statinInfo.cvdRisk == null || statinInfo.cvdRisk.level == CVDRiskLevel.VERY_HIGH) -> SimpleTheme.colors.material.error
+    isNonLabBasedStatinNudgeEnabled && (statinInfo.cvdRisk == null || statinInfo.cvdRisk.level == CVDRiskLevel.HIGH) -> SimpleTheme.colors.material.error
+    isLabBasedStatinNudgeEnabled && (statinInfo.isSmoker == Answer.Unanswered || statinInfo.cholesterol == null) ->
+      SimpleTheme.colors.onSurface67
 
-    statinInfo.isSmoker == Answer.Unanswered || statinInfo.bmiReading == null || statinInfo.cholesterol == null ->
+    isNonLabBasedStatinNudgeEnabled && (statinInfo.isSmoker == Answer.Unanswered || statinInfo.bmiReading == null) ->
       SimpleTheme.colors.onSurface67
 
     else -> SimpleTheme.colors.material.error
@@ -294,46 +300,67 @@ fun DescriptionText(
 @Composable
 @ReadOnlyComposable
 private fun descriptionText(
+    isNonLabBasedStatinNudgeEnabled: Boolean,
     isLabBasedStatinNudgeEnabled: Boolean,
     statinInfo: StatinInfo
 ): AnnotatedString {
-  val maxCvdRiskRange = statinInfo.cvdRisk?.max ?: 0
-
   return when {
     statinInfo.hasCVD -> stringResource(R.string.statin_alert_refer_to_doctor)
 
-    statinInfo.hasDiabetes && statinInfo.age >= MIN_AGE_FOR_STATIN && isLabBasedStatinNudgeEnabled.not() ->
+    statinInfo.hasDiabetes && statinInfo.age >= MIN_AGE_FOR_STATIN ->
       stringResource(R.string.statin_alert_refer_to_doctor_diabetic_40)
 
-    statinInfo.hasDiabetes && statinInfo.age >= MIN_AGE_FOR_STATIN && isLabBasedStatinNudgeEnabled && maxCvdRiskRange < LAB_BASED_MIN_REQ_MAX_RISK_RANGE ->
-      stringResource(R.string.statin_alert_refer_to_doctor_diabetic_40)
+    isLabBasedStatinNudgeEnabled -> labBasedDescriptionText(statinInfo)
+    isNonLabBasedStatinNudgeEnabled -> nonLabBasedDescriptionText(statinInfo)
 
-    statinInfo.cvdRisk == null || statinInfo.cvdRisk.level == CVDRiskLevel.HIGH ->
-      stringResource(R.string.statin_alert_refer_to_doctor)
+    else -> stringResource(R.string.statin_alert_refer_to_doctor)
+  }.toAnnotatedString()
+}
 
-    statinInfo.hasDiabetes && isLabBasedStatinNudgeEnabled ->
-      stringResource(R.string.statin_alert_refer_to_doctor_diabetic)
+@Composable
+@ReadOnlyComposable
+private fun labBasedDescriptionText(
+    statinInfo: StatinInfo
+): String {
+  return when {
 
-    statinInfo.isSmoker == Answer.Unanswered && statinInfo.bmiReading == null && isLabBasedStatinNudgeEnabled.not() ->
-      stringResource(R.string.statin_alert_add_smoking_and_bmi_info)
+    statinInfo.cvdRisk == null || statinInfo.cvdRisk.level == CVDRiskLevel.VERY_HIGH ->
+      stringResource(R.string.statin_alert_refer_to_doctor)
+
+    statinInfo.isSmoker == Answer.Unanswered && statinInfo.cholesterol == null ->
+      stringResource(R.string.statin_alert_add_smoking_and_cholesterol_info)
 
-    statinInfo.isSmoker == Answer.Unanswered && statinInfo.bmiReading != null && isLabBasedStatinNudgeEnabled.not() ->
+    statinInfo.isSmoker == Answer.Unanswered && statinInfo.cholesterol != null ->
       stringResource(R.string.statin_alert_add_smoking_info)
 
-    statinInfo.isSmoker != Answer.Unanswered && statinInfo.bmiReading == null && isLabBasedStatinNudgeEnabled.not() ->
-      stringResource(R.string.statin_alert_add_bmi_info)
+    statinInfo.isSmoker != Answer.Unanswered && statinInfo.cholesterol == null ->
+      stringResource(R.string.statin_alert_add_cholesterol_info)
 
-    statinInfo.isSmoker == Answer.Unanswered && statinInfo.cholesterol == null && isLabBasedStatinNudgeEnabled ->
-      stringResource(R.string.statin_alert_add_smoking_and_cholesterol_info)
+    else -> stringResource(R.string.statin_alert_refer_to_doctor)
+  }
+}
+
+@Composable
+@ReadOnlyComposable
+private fun nonLabBasedDescriptionText(
+    statinInfo: StatinInfo
+): String {
+  return when {
 
-    statinInfo.isSmoker == Answer.Unanswered && statinInfo.cholesterol != null && isLabBasedStatinNudgeEnabled ->
+    statinInfo.cvdRisk == null || statinInfo.cvdRisk.level == CVDRiskLevel.HIGH ->
+      stringResource(R.string.statin_alert_refer_to_doctor)
+
+    statinInfo.isSmoker == Answer.Unanswered && statinInfo.bmiReading == null ->
+      stringResource(R.string.statin_alert_add_smoking_and_bmi_info)
+
+    statinInfo.isSmoker == Answer.Unanswered && statinInfo.bmiReading != null ->
       stringResource(R.string.statin_alert_add_smoking_info)
 
-    statinInfo.isSmoker != Answer.Unanswered && statinInfo.cholesterol == null && isLabBasedStatinNudgeEnabled ->
-      stringResource(R.string.statin_alert_add_cholesterol_info)
+    statinInfo.isSmoker != Answer.Unanswered && statinInfo.bmiReading == null ->
+      stringResource(R.string.statin_alert_add_bmi_info)
 
     else -> stringResource(R.string.statin_alert_refer_to_doctor)
-  }.toAnnotatedString()
+  }
 }
 
 @Composable

app/src/main/res/values-si-rLK/strings.xml

@@ -926,7 +926,6 @@
   <string name="statin_alert_at_risk_patient">අවදානමක් සහිත රෝගීන්</string>
   <string name="statin_alert_refer_to_doctor">&lt;b&gt;ස්ටැටින් ප්‍රතිකාර&lt;/b&gt; සදහා වෛද්‍යවරයා වෙත යොමු කරන්න</string>
   <string name="statin_alert_refer_to_doctor_diabetic_40"> වයස අවුරුදු 40 ට වැඩි, දියවැඩියා රෝගියෙකු නම් ස්ටැටින් ඖෂධ සඳහා වෛද්‍යවරයා වෙත යොමු කරන්න</string>
-  <string name="statin_alert_refer_to_doctor_diabetic"> දියවැඩියා රෝගියෙකු නම් ස්ටැටින් ඖෂධ සඳහා වෛද්‍යවරයා වෙත යොමු කරන්න</string>
   <string name="statin_alert_add_smoking">දුම් පානය</string>
   <string name="statin_alert_add_bmi">BMI අගය</string>
   <string name="statin_alert_add_cholesterol">කොලෙස්ටරෝල් අගය එකතු කරන්න</string>

app/src/main/res/values-ta-rLK/strings.xml

@@ -925,7 +925,6 @@
   <string name="statin_alert_at_risk_patient">ஆபத்தில் உள்ள நோயாளி</string>
   <string name="statin_alert_refer_to_doctor">&lt;b&gt;ஸ்டேடின் மருந்துக்காக&lt;/b&gt; மருத்துவரை அணுகவும்</string>
   <string name="statin_alert_refer_to_doctor_diabetic_40">நீரிழிவு நோயாளி, 40 வயதுக்கு மேற்பட்டவர் எனின் ஸ்டேடின்(statin) மருந்துக்கு மருத்துவரை நாடவும்</string>
-  <string name="statin_alert_refer_to_doctor_diabetic"> நீரிழிவு நோயாளி எனின் ஸ்டேடின் மருந்துக்கு மருத்துவரைப் நாடவும்</string>
   <string name="statin_alert_add_smoking">புகைத்தலைச் சேர்க்க</string>
   <string name="statin_alert_add_bmi">உடற் திணிவுச் சுட்டியினை சேர்க்க</string>
   <string name="statin_alert_add_cholesterol">கொலஸ்ட்ரோலின் அளவைக் கூட்டுக</string>

app/src/main/res/values/strings.xml

@@ -1093,7 +1093,6 @@ The Simple app contains private health information of patients (“Data”).\n\n
   <string name="statin_alert_at_risk_patient">AT RISK PATIENT</string>
   <string name="statin_alert_refer_to_doctor">Refer to doctor for &lt;b&gt;statin medicine&lt;/b&gt;</string>
   <string name="statin_alert_refer_to_doctor_diabetic_40">Diabetic patient, age above 40. Refer to doctor for &lt;b&gt;statin medicine&lt;/b&gt;</string>
-  <string name="statin_alert_refer_to_doctor_diabetic">Diabetic patient. Refer to doctor for &lt;b&gt;statin medicine&lt;/b&gt;</string>
   <string name="statin_alert_add_smoking">Add smoking</string>
   <string name="statin_alert_add_bmi">Add BMI</string>
   <string name="statin_alert_add_cholesterol">Add cholesterol</string>

app/src/test/java/org/simple/clinic/summary/PatientSummaryUpdateTest.kt

@@ -2377,7 +2377,7 @@ class PatientSummaryUpdateTest {
   fun `when statin info is loaded, then update the state`() {
     val statinInfo = StatinInfo(
         canShowStatinNudge = true,
-        cvdRisk = CVDRiskRange(11, 11),
+        cvdRisk = CVDRiskRange(11, 27),
         isSmoker = Yes,
         bmiReading = BMIReading(165f, 60f),
         hasCVD = true,
@@ -2397,7 +2397,7 @@ class PatientSummaryUpdateTest {
                 isSmoking = Yes,
                 cholesterol = null,
             ),
-            riskRange = CVDRiskRange(11, 11),
+            riskRange = CVDRiskRange(11, 27),
             bmiReading = BMIReading(165f, 60f),
         ))
         .then(assertThatNext(
@@ -2445,45 +2445,6 @@ class PatientSummaryUpdateTest {
         ))
   }
 
-  @Test
-  fun `when statin info is loaded and lab-based statin is enabled and has diabetes, then statin can be prescribed`() {
-    val statinInfo = StatinInfo(
-        canShowStatinNudge = true,
-        cvdRisk = null,
-        isSmoker = Yes,
-        bmiReading = BMIReading(165f, 60f),
-        hasCVD = true,
-        hasDiabetes = true,
-        age = 55,
-        cholesterol = null,
-    )
-    val updateSpec = UpdateSpec(PatientSummaryUpdate(
-        isPatientReassignmentFeatureEnabled = true,
-        isPatientStatinNudgeV1Enabled = true,
-        isNonLabBasedStatinNudgeEnabled = true,
-        isLabBasedStatinNudgeEnabled = true,
-    ))
-
-    updateSpec
-        .given(defaultModel)
-        .whenEvent(StatinInfoLoaded(
-            age = 55,
-            medicalHistory = TestData.medicalHistory(
-                hasHadStroke = Yes,
-                hasHadHeartAttack = Yes,
-                hasDiabetes = Yes,
-                isSmoking = Yes,
-                cholesterol = null,
-            ),
-            riskRange = CVDRiskRange(9, 9),
-            bmiReading = BMIReading(165f, 60f),
-        ))
-        .then(assertThatNext(
-            hasModel(defaultModel.updateStatinInfo(statinInfo)),
-            hasNoEffects()
-        ))
-  }
-
   @Test
   fun `when statin info is loaded and lab-based statin is enabled and has diabetes and max risk is less than 10, then statin cannot be prescribed`() {
     val statinInfo = StatinInfo(
@@ -2527,7 +2488,7 @@ class PatientSummaryUpdateTest {
   fun `when statin info is loaded and risk is low-high, then update the state and show smoking status dialog`() {
     val statinInfo = StatinInfo(
         canShowStatinNudge = true,
-        cvdRisk = CVDRiskRange(4, 11),
+        cvdRisk = CVDRiskRange(4, 27),
         isSmoker = Unanswered,
         bmiReading = BMIReading(165f, 60f),
         hasCVD = true,
@@ -2546,7 +2507,7 @@ class PatientSummaryUpdateTest {
                 isSmoking = Unanswered,
                 cholesterol = null,
             ),
-            riskRange = CVDRiskRange(4, 11),
+            riskRange = CVDRiskRange(4, 27),
             bmiReading = BMIReading(165f, 60f),
         ))
         .then(assertThatNext(