Show statin nudge for 90 calendar days and recalculate cvd risk after 90 days #5185

siddh1004 · 2025-01-17T13:19:54Z

https://app.shortcut.com/simpledotorg/story/14495/statin-nudge-v2-android-engineering-discussions?team_id=1&iteration_ids=14465

Update refer text for cvd risk min value greater than or equal to 10

msasikanth · 2025-01-22T02:02:18Z

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

    dao.saveRisk(cvdRisk)
  }

+  fun save(cvdRisk: CVDRisk, updateTime: Instant) {


Let's keep the name consistent with the data, rename to updatedAt

msasikanth · 2025-01-23T06:27:04Z

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

+
+                    val wasCVDCalculatedWithin90Days = cvdRisk.timestamps.updatedAt > ninetyDaysAgo
+
+                    val patientAttribute = patientAttributeRepository.getPatientAttributeImmediate(patientUuid = patient.uuid)


Just confirming, if the patient attribute changes, don't we have to recalculate or load the info again?

No, patient attribute only change when BMI is added, and we have a event to handle this case. So we don't need to observe this situation

msasikanth · 2025-01-23T06:32:34Z

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

 import androidx.room.RawQuery
 import androidx.sqlite.db.SimpleSQLiteQuery
 import io.reactivex.Flowable
+import io.reactivex.Observable


Unused import?

msasikanth · 2025-01-23T06:36:46Z

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

+                      medicalHistoryRepository.hasMedicalHistoryForPatientChangedSince(
+                          patientUuid = patient.uuid,
+                          instant = cvdRisk?.timestamps?.updatedAt ?: today,
+                      ),


I am just thinking, can't we just place a observable to get medical history for patient and then compare the updatedAt time with the CVD risk created time if it's not null in the update function?

Do we need another query to do this? 🤔

Thanks for the feedback. Sounds really good and implemented that

msasikanth · 2025-01-23T06:38:50Z

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

+                        .atStartOfDay(userClock.zone)
+                        .toInstant()
+                    val wasBPMeasuredWithin90Days = newestBp.firstOrNull()?.updatedAt?.let { updatedAt ->
+                      updatedAt > ninetyDaysAgo


According the naming semantics shouldn't the condition be updatedAt < ninetyDaysAgo? Only then it would be true, no?

No, i think it should be the way it has been done. We need the BP to be calculated after the ninety day time. So updatedAt has to greater than ninetyDayAgo.

Yeah, that's why I was mentioning that condition. This variable will be false if the BP is measured with in 90 days right? Unless I misunderstand it.

So shouldn't the variable name be isBPMeasuredMoreThan90DaysAgo or the condition needs to be <, no?

msasikanth · 2025-01-23T06:39:09Z

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

+                    } ?: false
+
+                    val wasCVDCalculatedWithin90Days = cvdRisk?.let { risk ->
+                      risk.timestamps.updatedAt > ninetyDaysAgo


Same comment as above regarding the condition

same comment as above

msasikanth · 2025-01-23T06:40:53Z

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

+            var risk: CVDRiskRange? = null
+
+            if (bloodPressure != null) {
+              risk = cvdRiskCalculator.calculateCvdRisk(
+                  CVDRiskInput(
+                      gender = patient.gender,
+                      age = patient.ageDetails.estimateAge(userClock),
+                      systolic = bloodPressure.reading.systolic,
+                      isSmoker = medicalHistory.isSmoking,
+                      bmi = patientAttribute?.bmiReading?.calculateBMI(),
+                  )
              )
            }
+
+            if (risk != null) {
+              val existingCvdRisk = cvdRiskRepository.getCVDRiskImmediate(patient.uuid)
+              if (existingCvdRisk != null) {
+                cvdRiskRepository.save(
+                    existingCvdRisk.copy(riskScore = risk),
+                    updateTime = Instant.now(clock)
+                )
+              } else {
+                cvdRiskRepository.save(
+                    riskScore = risk,
+                    patientUuid = patient.uuid,
+                    uuid = uuidGenerator.v4()
+                )
+              }
+            }


I don't think these conditions should be part of the effect handler, Update function should make the decision on whether to update or create a new one and trigger respective side effects. Please make that change.

Also, we are technically doing 2 separate side effects here. We are calculating the risk and also saving/updating them right there. Calculating them and modifying them are 2 separate actions. We can break them down accordingly.

Done. Broke this into new events and effects

msasikanth · 2025-01-23T06:43:53Z

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

+        if (event.cvdRiskRange == null ||
+            event.hasMedicalHistoryChanged ||
+            !event.wasCVDCalculatedWithin90Days) {
+          dispatch(CalculateCVDRisk(model.patientSummaryProfile!!.patient))
+        } else {
+          dispatch(LoadStatinInfo(model.patientUuid))
+        }


Nested conditional, let's break it down

msasikanth · 2025-01-23T06:44:31Z

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

+              IntOffset(
+                  x = clampedOffsetX.toInt(),
+                  y = 0
+              )


Can you check code styling once? Diff shows whitespaces being added here.

msasikanth · 2025-01-23T10:57:16Z

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

      is StatinPrescriptionCheckInfoLoaded -> statinPrescriptionCheckInfoLoaded(event, model)
-      is CVDRiskCalculated -> dispatch(LoadStatinInfo(model.patientUuid))
+      is CVDRiskCalculated -> saveOrUpdateCVDRisk(event, model)
+      is CVDRiskUpdated -> dispatch(LoadStatinInfo(model.patientUuid))


This was the reason why I thought we can use a observable stream for CVD risk, since that will load the statin info automatically without having to call it manually everytime it's updated or saved.

You can make this change later though

siddh1004 force-pushed the siddharth-agarwal/sc-14495 branch 4 times, most recently from f57b392 to 78d9ff4 Compare January 20, 2025 10:21

siddh1004 changed the title ~~Update cv risk when smoking status is updated~~ Update cv risk business logic Jan 20, 2025

siddh1004 force-pushed the siddharth-agarwal/sc-14495 branch 2 times, most recently from 68242a4 to 61c7e6b Compare January 20, 2025 13:57

msasikanth force-pushed the siddharth-agarwal/sc-14495 branch from 61c7e6b to be8a96f Compare January 22, 2025 04:19

Siddharth Agarwal added 6 commits January 22, 2025 18:20

Observe medical history to recalculate cvd risk

a756df9

Rename hasMedicalHistoryForPatientChangedSince to immediate

ce812d7

Add hasMedicalHistoryForPatientChangedSince

f4bb053

Calculate cvd risk when medical history is changed

ce8c1b6

Update cvd risk when it is exists and not deleted

aacea75

Remove UHC facility check from statin nudge

b1323b7

siddh1004 force-pushed the siddharth-agarwal/sc-14495 branch from be8a96f to 7371b6b Compare January 22, 2025 12:51

siddh1004 changed the title ~~Update cv risk business logic~~ Show statin nudge for 90 calendar days and recalculate cvd risk after 90 days Jan 22, 2025

siddh1004 marked this pull request as ready for review January 22, 2025 13:54

simple-services requested review from a team and msasikanth and removed request for a team January 22, 2025 13:54

github-actions bot enabled auto-merge (squash) January 22, 2025 13:54

msasikanth and others added 6 commits January 23, 2025 11:44

Combine flat maps into one method

4a400a6

Revert patient profile change

6c19a89

Show statin nudge for 90 calendar days

6ea8a4b

Remove unwanted observables

f2117e3

Update refer text for cvd risk

78081e8

Update refer text for cvd risk min value greater than or equal to 10

Update colour for cvd risk refer text

43d9b55

siddh1004 force-pushed the siddharth-agarwal/sc-14495 branch from a610ed4 to 43d9b55 Compare January 23, 2025 06:14

Use 140 as threshold for SBP less than 140

c953955

msasikanth suggested changes Jan 23, 2025

View reviewed changes

Siddharth Agarwal added 2 commits January 23, 2025 14:57

Refactor code

19ec8e8

Add event to update or save cvd risk when calculated

00c5681

siddh1004 requested a review from msasikanth January 23, 2025 10:51

msasikanth reviewed Jan 23, 2025

View reviewed changes

msasikanth approved these changes Jan 23, 2025

View reviewed changes

github-actions bot merged commit 6279eff into master Jan 23, 2025
8 of 9 checks passed

github-actions bot deleted the siddharth-agarwal/sc-14495 branch January 23, 2025 10:57


		val wasCVDCalculatedWithin90Days = cvdRisk.timestamps.updatedAt > ninetyDaysAgo

		val patientAttribute = patientAttributeRepository.getPatientAttributeImmediate(patientUuid = patient.uuid)

Show statin nudge for 90 calendar days and recalculate cvd risk after 90 days #5185

Show statin nudge for 90 calendar days and recalculate cvd risk after 90 days #5185

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siddh1004 commented Jan 17, 2025

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