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feat(web): two-stage questionnaires, screening result and diary by result

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- Sign-in: centred ЕМИАС card without the sidebar; anonymous entry asks «Депрессия / ПТСР».
- Stage 1 is the same for everyone and follows the fixed order of the MVP questionnaire:
  PHQ-2 → trauma filter/TSQ → RUS-AUDIT-S → C-SSRS → context; stage 2 only where stage 1
  is positive. Starts without a profile.
- After stage 1 the patient sees a preliminary result (screening, not a diagnosis), stored
  with the record; it switches on the diary modules (depression / PTSD).
- Stage 2 diary: morning (sleep, sleep quality, alcohol) and evening (mood, medication,
  3 PHQ-9 items in rotation, short PCL-5); C-SSRS since last contact only under risk;
  flags on weekly means against the personal norm; scheduled full scales with change
  (remission, response, worsening).
- Questionnaire log: GET /me/{token}/results and the «Мои результаты» screen.
- Questionnaires centred without the sidebar and without scale names; «Продолжить позже»
  goes home; confirmations are toasts; free-text comments are optional.
- Demo policy config/questionnaire_demo.yaml (INTAKE_DEMO only, not a clinical approval).

ADR-012.

Refs #77

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
This commit is contained in:
Arxip222
2026-10-04 15:14:09 +03:00
co-authored by Claude Opus 5.5
parent 6e7c89900b
commit 290b0d6151
36 changed files with 1900 additions and 691 deletions
Download Patch File Download Diff File Expand all files Collapse all files
tests/test_dialog_intake.py
+125 -58
View File
@@ -94,6 +94,17 @@ async def complete_intake(e, choices=None):
raise AssertionError("intake did not terminate")
async def to_cssrs(e, choices=None):
"""Stage 1 up to the C-SSRS screener, which comes after PHQ-2, the trauma filter and RUS-AUDIT-S."""
replies = await press(e, "intake:start")
for _ in range(20):
button = answer_button(replies, {"trauma": 1, **(choices or {})})
if ":cssrs_" in button:
return replies
replies = await press(e, button)
raise AssertionError("C-SSRS not reached")
async def test_minimal_intake_raw_data_not_imputed_and_restart(released):
await complete_intake(released, {"trauma": 1, "tbi": 1, "psychotropics": 1})
(row,) = await rows()
@@ -111,13 +122,13 @@ async def test_pause_restart_and_duplicate_callbacks(released):
old = answer_button(replies)
await asyncio.gather(press(released, old), press(released, old))
(row,) = await rows()
assert row.answers == {"cssrs_q1": 0}
assert row.answers == {"phq9_1": 0}
await press(released, "intake:pause")
restarted = Engine(gateway=LLMGateway(MockTasks()))
replies = await press(restarted, "intake:resume")
assert "cssrs_q2" in answer_button(replies)
assert "phq9_2" in answer_button(replies)
await press(restarted, old)
assert (await rows())[0].answers == {"cssrs_q1": 0}
assert (await rows())[0].answers == {"phq9_1": 0}
assert all(len(b.data.encode()) <= 64 for r in replies for line in r.buttons for b in line)
@@ -127,6 +138,7 @@ async def test_immediate_stop_preserves_partial_answers(released, signal):
if signal == "help":
replies = await press(released, "intake:help")
elif signal == "cssrs":
replies = await to_cssrs(released)
for item in ("cssrs_q1", "cssrs_q2", "cssrs_q3", "cssrs_q4"):
replies = await press(released, answer_button(replies, {item: 0}))
else:
@@ -169,12 +181,13 @@ async def test_alcohol_conflict_keeps_positive_short_answer(released):
async def test_low_risk_shows_safety_plan_but_moderate_stops(released):
replies = await press(released, "intake:start")
replies = await to_cssrs(released)
replies = await press(released, answer_button(replies, {"cssrs_q1": 0}))
replies = await press(released, answer_button(replies))
replies = await press(released, answer_button(replies))
assert any(r.kind == "safety_plan" for r in replies)
assert "phq9_1" in answer_button(replies)
# The screener ends stage 1; the context questions follow (sex is known from the profile).
assert ":tbi:" in answer_button(replies)
async def test_notification_failure_retry_and_consent_cancellation(released, monkeypatch):
@@ -210,9 +223,10 @@ async def test_scheduler_idempotent_and_failed_outbox_recovery(released, monkeyp
monkeypatch.setattr(integrations, "outbox", Failing())
await jobs.run_until_now()
tasks = await rows(QuestionnaireTask)
assert len(tasks) == 2
risk = next(t for t in tasks if t.kind == "cssrs_since_contact")
assert risk.delivery and risk.sent_at is None
# 20:00 Moscow: both parts of the diary are due; no risk monitoring → no daily C-SSRS.
assert {t.kind for t in tasks} == {"diary_morning", "diary_evening"}
morning = next(t for t in tasks if t.kind == "diary_morning")
assert morning.delivery and morning.sent_at is None
outbox = MemoryOutbox()
monkeypatch.setattr(integrations, "outbox", outbox)
await jobs.run_until_now()
@@ -222,17 +236,29 @@ async def test_scheduler_idempotent_and_failed_outbox_recovery(released, monkeyp
assert len(await rows()) == 2
async def test_missing_since_contact_is_manual_review_not_recent(released):
async def test_since_contact_risk_check_opens_the_evening_diary(released):
async with session.get_clinical_session() as s:
task = await service.queue_task(s, TOKEN, "cssrs_since_contact", "synthetic", NOW)
task_id = task.id
replies = await released.handle(
TOKEN, Event(type="system", system="daily_checkin", params={"questionnaire_task": task_id})
)
(row,) = await rows()
assert row.kind == "cssrs_since_contact" and row.status == "review_required" and not row.answers
assert row.details["stop_reason"] == "cssrs_since_contact_required"
assert not answer_button(replies)
assert any("последнего ответа" in r.text for r in replies)
for _ in range(5):
button = answer_button(replies)
if ":cssrs_" not in (button or ""):
break
replies = await press(released, button)
risk = next(r for r in await rows() if r.kind == "cssrs_since_contact")
assert risk.status == "complete" and risk.answers == {
"cssrs_q1": 0,
"cssrs_q2": 0,
"cssrs_q6_lifetime": 0,
"cssrs_q6_recent": 0,
}
assert risk.details["answer_metadata"]["cssrs_q6_recent"]["derived"] is True
assert ":mood:" in answer_button(replies)
assert any(r.kind == "diary_evening" and r.status == "active" for r in await rows())
async def test_disabled_or_no_adult_confirmation_cannot_start(released):
@@ -256,6 +282,20 @@ async def review_risk_record(e):
)
async def run_diary(e, replies, choices=None, numbers=("6,5", "2")):
"""Answers the open diary questions; numeric items take `numbers` in turn."""
numbers = list(numbers)
for _ in range(30):
button = answer_button(replies, choices)
if button:
replies = await press(e, button)
elif any("часов" in r.text or "порци" in r.text for r in replies) and numbers:
replies = await e.handle(TOKEN, Event(type="text", text=numbers.pop(0)))
else:
return replies
raise AssertionError("diary did not terminate")
async def test_doctor_review_is_audited_and_unblocks_diary(released):
from fastapi import HTTPException
@@ -263,8 +303,14 @@ async def test_doctor_review_is_audited_and_unblocks_diary(released):
from app.db.audit import AuditLog
await complete_intake(released, {"trauma": 1, "tbi": 1, "psychotropics": 1})
await jobs.run_until_now()
async with session.get_clinical_session() as s:
(await repo.get_profile(s, TOKEN)).enhanced_monitoring = True
replies = await run_diary(released, await press(released, "menu:checkin"))
# Evening: the risk check comes first; thoughts of a method (q3) are a moderate risk → stop for a specialist.
replies = await press(released, "menu:checkin")
replies = await complete_existing(released, replies, {"cssrs_q1": 0, "cssrs_q2": 0, "cssrs_q3": 0})
risk = next(r for r in await rows() if r.kind == "cssrs_since_contact")
assert risk.status == "review_required"
with pytest.raises(HTTPException) as exc:
await review(
TOKEN,
@@ -277,53 +323,43 @@ async def test_doctor_review_is_audited_and_unblocks_diary(released):
assert (await repo.get_dialog_state(s, TOKEN)).data.get("intake_review_required")
await review_risk_record(released)
await jobs.run_until_now()
assert any(r.kind == "diary" and r.status == "active" for r in await rows())
assert any(r.kind == "diary_evening" and r.status == "active" for r in await rows())
await history(TOKEN, "synthetic-doctor")
audits = await rows(AuditLog)
assert {a.action for a in audits} >= {"view_questionnaires", "review_questionnaire"}
async def test_diary_numeric_skip_and_not_prescribed(released):
async def test_diary_morning_then_evening_with_the_ptsd_module(released):
await complete_intake(released, {"trauma": 1, "tbi": 1, "psychotropics": 1})
await press(released, "menu:checkin")
await review_risk_record(released)
replies = await press(released, "menu:checkin")
for _ in range(30):
q = next(
(b.data.split(":")[2] for r in replies for line in r.buttons for b in line if b.data.startswith("iq:")),
None,
)
if q == "comment":
button = next(b.data for r in replies for line in r.buttons for b in line if b.data.endswith(":skip"))
replies = await press(released, button)
elif q:
replies = await press(released, answer_button(replies, {"medication": 3}))
elif any("часов" in r.text for r in replies):
invalid = await released.handle(TOKEN, Event(type="text", text="nan"))
assert any("число часов" in r.text for r in invalid)
replies = await released.handle(TOKEN, Event(type="text", text="6,5"))
else:
break
diary = next(r for r in await rows() if r.kind == "diary")
assert diary.status == "complete" and diary.answers["sleep_hours"] == 6.5
assert "medication_reason" not in diary.answers and "side_effects" not in diary.answers
assert diary.answers["comment"] is None
assert any("часов" in r.text for r in replies)
invalid = await released.handle(TOKEN, Event(type="text", text="nan"))
assert any("число часов" in r.text for r in invalid)
replies = await run_diary(released, invalid, {"sleep_quality": 3})
assert any("утро" in r.text for r in replies)
morning = next(r for r in await rows() if r.kind == "diary_morning")
assert morning.status == "complete"
assert morning.answers == {"sleep_hours": 6.5, "sleep_quality": 3, "alcohol_portions": 2.0}
replies = await run_diary(released, await press(released, "menu:checkin"), {"mood": 7, "medication": 2})
evening = next(r for r in await rows() if r.kind == "diary_evening")
assert evening.status == "complete" and evening.answers["medication"] == "not_prescribed"
assert "medication_reason" not in evening.answers
assert {"dpcl_1", "dpcl_7", "dpcl_10", "dpcl_18"} <= set(evening.answers)
assert evening.details["interpretation"]["kind"] == "diary_evening"
replies = await press(released, "menu:checkin")
assert any("уже заполнен" in r.text for r in replies)
async def test_high_risk_diary_asks_safety_first_and_stops(released):
async def test_depression_module_item9_stops_with_crisis(released, monkeypatch):
await complete_intake(released, {"trauma": 1, "tbi": 1, "psychotropics": 1})
async with session.get_clinical_session() as s:
(await repo.get_profile(s, TOKEN)).enhanced_monitoring = True
await press(released, "menu:checkin")
await review_risk_record(released)
replies = await press(released, "menu:checkin")
button = answer_button(replies)
assert "death_thoughts" in button
replies = await press(released, button)
await repo.upsert_profile(s, token=TOKEN, modules=["depression"])
monkeypatch.setattr(clock, "now", lambda: NOW + timedelta(days=2))
await run_diary(released, await press(released, "menu:checkin"))
replies = await run_diary(released, await press(released, "menu:checkin"), {"medication": 2, "dphq_9": 1})
assert any(r.kind == "crisis" for r in replies)
assert any(b.data == "safety_plan" for r in replies for line in r.buttons for b in line)
diary = next(r for r in await rows() if r.kind == "diary")
assert diary.answers == {"death_thoughts": 1} and diary.status == "interrupted"
evening = next(r for r in await rows() if r.kind == "diary_evening")
assert evening.answers["dphq_9"] == 1 and evening.status == "interrupted"
async def test_unknown_sex_goes_to_review_without_a_zone(released):
@@ -344,7 +380,7 @@ async def test_version_change_blocks_resume_and_preserves_answers(released):
path.write_text(yaml.safe_dump(data, allow_unicode=True))
await press(released, "intake:resume")
(row,) = await rows()
assert row.status == "review_required" and row.answers == {"cssrs_q1": 0}
assert row.status == "review_required" and row.answers == {"phq9_1": 0}
async def test_followup_delta_uses_comparable_complete_baseline(released):
@@ -377,20 +413,23 @@ async def test_stop_any_policy_interrupts_first_positive(released):
data = yaml.safe_load(path.read_text())
data["cssrs_positive_policy"] = "stop_any"
path.write_text(yaml.safe_dump(data, allow_unicode=True))
replies = await press(released, "intake:start")
replies = await to_cssrs(released)
replies = await press(released, answer_button(replies, {"cssrs_q1": 0}))
assert any(r.kind == "crisis" for r in replies)
assert (await rows())[0].answers == {"cssrs_q1": 1}
assert (await rows())[0].answers["cssrs_q1"] == 1
async def test_evening_schedule_uses_moscow_date(released, monkeypatch):
async def test_diary_schedule_uses_moscow_date(released, monkeypatch):
await complete_intake(released, {"trauma": 1, "tbi": 1, "psychotropics": 1})
monkeypatch.setattr(clock, "now", lambda: NOW.replace(hour=15, minute=59))
monkeypatch.setattr(clock, "now", lambda: NOW.replace(hour=4, minute=59))
await jobs.plan()
assert await rows(QuestionnaireTask) == []
monkeypatch.setattr(clock, "now", lambda: NOW.replace(hour=16, minute=0))
monkeypatch.setattr(clock, "now", lambda: NOW.replace(hour=5, minute=0))
await jobs.plan()
assert {t.kind for t in await rows(QuestionnaireTask)} == {"diary", "cssrs_since_contact"}
assert {t.kind for t in await rows(QuestionnaireTask)} == {"diary_morning"}
monkeypatch.setattr(clock, "now", lambda: NOW.replace(hour=17, minute=0))
await jobs.plan()
assert {t.kind for t in await rows(QuestionnaireTask)} == {"diary_morning", "diary_evening"}
async def test_resumed_answer_keeps_original_period(released, monkeypatch):
@@ -401,7 +440,35 @@ async def test_resumed_answer_keeps_original_period(released, monkeypatch):
replies = await press(released, "intake:resume")
await press(released, answer_button(replies))
(record,) = await rows()
metadata = record.details["answer_metadata"]["cssrs_q2"]
assert metadata["period_start"] == "2026-09-03"
metadata = record.details["answer_metadata"]["phq9_2"]
assert metadata["period_start"] == "2026-09-19"
assert metadata["period_end"] == "2026-10-03"
assert metadata["answered_at"].startswith("2026-10-04")
async def test_intake_result_is_shown_logged_and_sets_the_diary_modules(released):
from app.api.patient_web import my_results
choices = {f"phq9_{i}": 2 for i in range(1, 9)}
choices.update(trauma=1, tbi=1, psychotropics=1)
replies = await complete_intake(released, choices)
assert any("Предположение депрессии" in r.text for r in replies)
assert any("не диагноз" in r.text for r in replies)
(row,) = await rows()
interpretation = row.details["interpretation"]
assert interpretation["codes"] == ["depression_suspected"] and interpretation["modules"] == ["depression"]
async with session.get_clinical_session() as s:
# A doctor's modules (diagnosis) stay; the screening only adds to them.
assert (await repo.get_profile(s, TOKEN)).modules == ["veteran", "depression"]
results = await my_results(TOKEN)
assert results.conclusion.title == interpretation["title"]
assert [h.kind for h in results.history] == ["intake"] and results.history[0].status_title == "пройден"
async def test_without_a_doctor_the_screening_defines_the_modules(released):
async with session.get_clinical_session() as s:
await repo.upsert_profile(s, token=TOKEN, doctor_id="", modules=["veteran"])
replies = await complete_intake(released, {"trauma": 1, "tbi": 1, "psychotropics": 1})
assert any("не выявлено" in r.text for r in replies)
async with session.get_clinical_session() as s:
assert (await repo.get_profile(s, TOKEN)).modules == []