feat(questionnaire): integrate revised intake and follow-up monitoring

Add gated TSQ, Russian C-SSRS Recent, durable responses and notifications, diaries, schedules and audited clinical review. Preserve manual assessment when the Russian follow-up source is unavailable. Refs #52
2026-10-03 18:19:34 +03:00
parent 8b61eecf1b
commit c42ef621e5
34 changed files with 2556 additions and 85 deletions
@@ -0,0 +1,407 @@
+"""Synthetic released-config integration tests. Production approvals stay empty."""
+
+import asyncio
+import shutil
+from datetime import UTC, datetime, timedelta
+
+import pytest
+import yaml
+from sqlalchemy import select
+
+from app.config import get_settings
+from app.core import clock
+from app.core.scales import clear_cache
+from app.db import repo, session
+from app.db.bootstrap import init_db
+from app.db.intake import QuestionnaireNotice, QuestionnaireRecord, QuestionnaireTask
+from app.dialog.contracts import Event
+from app.dialog.engine import Engine
+from app.integrations.base import MemoryNotifier, MemoryOutbox, integrations
+from app.llm.gateway import LLMGateway
+from app.llm.mock import MockTasks
+from app.scheduler import jobs
+from app.services import questionnaire as service
+
+TOKEN = "b" * 32
+NOW = datetime(2026, 10, 3, 17, tzinfo=UTC)
+
+
+@pytest.fixture
+async def released(tmp_path, monkeypatch):
+    config = tmp_path / "config"
+    shutil.copytree(get_settings().config_dir, config)
+    for name in ("questionnaire", "intake_runtime"):
+        path = config / f"{name}.yaml"
+        data = yaml.safe_load(path.read_text())
+        approval = dict(
+            reviewer="Synthetic test",
+            decision_reference="fixture-only",
+            approved_at=NOW.isoformat(),
+            policy_version=data["version"],
+        )
+        data["approval"] = approval
+        if name == "questionnaire":
+            data.update(cssrs_positive_policy="graded", rus_audit_s_expand_at=1)
+        else:
+            data.update(enabled=True, content_review=approval, contact_review=approval)
+        path.write_text(yaml.safe_dump(data, allow_unicode=True))
+    monkeypatch.setattr(get_settings(), "config_dir", config)
+    monkeypatch.setattr(clock, "now", lambda: NOW)
+    monkeypatch.setattr(integrations, "notifier", MemoryNotifier())
+    monkeypatch.setattr(integrations, "outbox", MemoryOutbox())
+    clear_cache()
+    await session.configure(identity_url="sqlite+aiosqlite:///:memory:", clinical_url="sqlite+aiosqlite:///:memory:")
+    await init_db()
+    async with session.get_clinical_session() as s:
+        await repo.upsert_profile(s, token=TOKEN, doctor_id="synthetic-doctor", modules=["veteran"], sex="m")
+        await repo.set_dialog_state(s, token=TOKEN, state="idle", data={"consent": True, "adult": True}, now=NOW)
+    yield Engine(gateway=LLMGateway(MockTasks()))
+    await session.configure()
+    clear_cache()
+
+
+async def rows(cls=QuestionnaireRecord):
+    async with session.get_clinical_session() as s:
+        return list((await s.scalars(select(cls))).all())
+
+
+async def press(e, data):
+    return await e.handle(TOKEN, Event(type="button", button=data))
+
+
+def answer_button(replies, choices=None):
+    choices = choices or {}
+    for reply in reversed(replies):
+        for line in reply.buttons:
+            for b in line:
+                if b.data.startswith("iq:"):
+                    item = b.data.split(":")[2]
+                    index = choices.get(item, 1 if item.startswith("cssrs_") else 0)
+                    for line2 in reply.buttons:
+                        for other in line2:
+                            if other.data.endswith(":" + str(index)) and other.data.startswith("iq:"):
+                                return other.data
+    return None
+
+
+async def complete_intake(e, choices=None):
+    replies = await press(e, "intake:start")
+    for _ in range(100):
+        button = answer_button(replies, choices)
+        if button is None:
+            return replies
+        replies = await press(e, button)
+    raise AssertionError("intake did not terminate")
+
+
+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()
+    assert row.status == "complete"
+    assert row.answers["trauma"] == 0 and not any(k.startswith("tsq_") for k in row.answers)
+    assert row.details["totals"]["tsq"]["total"] is None
+    assert row.details["totals"]["phq9"]["total"] is None
+    assert row.details["totals"]["rus_audit_s"]["total"] == 0
+    assert row.details["totals"]["cssrs_recent"]["risk"] == "none"
+    assert row.details["decision"]["primary_route"] == "self_help"
+
+
+async def test_pause_restart_and_duplicate_callbacks(released):
+    replies = await press(released, "intake:start")
+    old = answer_button(replies)
+    await asyncio.gather(press(released, old), press(released, old))
+    (row,) = await rows()
+    assert row.answers == {"cssrs_q1": 0}
+    await press(released, "intake:pause")
+    restarted = Engine(gateway=LLMGateway(MockTasks()))
+    replies = await press(restarted, "intake:resume")
+    assert "cssrs_q2" in answer_button(replies)
+    await press(restarted, old)
+    assert (await rows())[0].answers == {"cssrs_q1": 0}
+    assert all(len(b.data.encode()) <= 64 for r in replies for line in r.buttons for b in line)
+
+
+@pytest.mark.parametrize("signal", ["help", "phq", "cssrs"])
+async def test_immediate_stop_preserves_partial_answers(released, signal):
+    replies = await press(released, "intake:start")
+    if signal == "help":
+        replies = await press(released, "intake:help")
+    elif signal == "cssrs":
+        for item in ("cssrs_q1", "cssrs_q2", "cssrs_q3", "cssrs_q4"):
+            replies = await press(released, answer_button(replies, {item: 0}))
+    else:
+        replies = await complete_existing(released, replies, {"trauma": 1, "phq9_1": 2, "phq9_9": 1})
+    assert any(r.kind == "crisis" for r in replies)
+    (row,) = await rows()
+    assert row.status == "interrupted" and row.completed_at is None
+    notices = await rows(QuestionnaireNotice)
+    assert len(notices) == 1 and notices[0].status == "test_sink"
+    assert "уведомлён" not in replies[0].text
+
+
+async def complete_existing(e, replies, choices):
+    for _ in range(100):
+        button = answer_button(replies, choices)
+        if not button:
+            return replies
+        replies = await press(e, button)
+    raise AssertionError("not terminated")
+
+
+async def test_full_tsq_expands_at_six_and_carries_alcohol_answers(released):
+    choices = {"tsq_" + str(i): 0 if i <= 6 else 1 for i in range(1, 11)}
+    choices.update(rus_audit_3=1, rus_audit_1=1, tbi=1, psychotropics=1)
+    await complete_intake(released, choices)
+    (row,) = await rows()
+    assert row.status == "complete"
+    assert row.details["totals"]["tsq"]["total"] == 6
+    assert row.details["totals"]["pcl5"]["total"] == 0
+    assert row.details["totals"]["rus_audit"]["complete"]
+    assert row.answers["rus_audit_3"] == 1
+    assert len([k for k in row.answers if k.startswith("rus_audit_")]) == 10
+
+
+async def test_alcohol_conflict_keeps_positive_short_answer(released):
+    await complete_intake(released, {"trauma": 1, "rus_audit_3": 1, "rus_audit_1": 0})
+    (row,) = await rows()
+    assert row.status == "review_required" and row.answers["rus_audit_3"] == 1
+    assert row.details["stop_reason"] == "answer_conflict"
+
+
+async def test_low_risk_shows_safety_plan_but_moderate_stops(released):
+    replies = await press(released, "intake:start")
+    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)
+
+
+async def test_notification_failure_retry_and_consent_cancellation(released, monkeypatch):
+    class Failing:
+        async def send(self, *args, **kwargs):
+            raise OSError("sensitive error content must not be stored")
+
+    monkeypatch.setattr(integrations, "notifier", Failing())
+    await press(released, "intake:start")
+    await press(released, "intake:help")
+    (notice,) = await rows(QuestionnaireNotice)
+    assert notice.status == "pending" and notice.error_code == "OSError" and notice.attempts == 1
+    monkeypatch.setattr(clock, "now", lambda: NOW + timedelta(minutes=3))
+    notifier = MemoryNotifier()
+    monkeypatch.setattr(integrations, "notifier", notifier)
+    await service.dispatch_notices()
+    await service.dispatch_notices()
+    assert len(notifier.sent) == 1
+    assert (await rows(QuestionnaireNotice))[0].attempts == 2
+    await press(released, "consent:revoke")
+    async with session.get_clinical_session() as s:
+        state = await repo.get_dialog_state(s, TOKEN)
+        assert state.data["consent"] is False and "questionnaire_record" not in state.data
+
+
+async def test_scheduler_idempotent_and_failed_outbox_recovery(released, monkeypatch):
+    await complete_intake(released, {"trauma": 1, "tbi": 1, "psychotropics": 1})
+
+    class Failing:
+        async def push(self, *args):
+            raise OSError()
+
+    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
+    outbox = MemoryOutbox()
+    monkeypatch.setattr(integrations, "outbox", outbox)
+    await jobs.run_until_now()
+    await jobs.run_until_now()
+    assert len(await rows(QuestionnaireTask)) == 2
+    assert len(outbox.drain(TOKEN)) == 1
+    assert len(await rows()) == 2
+
+
+async def test_missing_since_contact_is_manual_review_not_recent(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)
+
+
+async def test_disabled_or_no_adult_confirmation_cannot_start(released):
+    async with session.get_clinical_session() as s:
+        state = await repo.get_dialog_state(s, TOKEN)
+        state.data = {"consent": True}
+    await press(released, "intake:start")
+    assert await rows() == []
+
+
+async def review_risk_record(e):
+    from app.api.questionnaire import ReviewIn, review
+
+    risk = next(r for r in reversed(await rows()) if r.kind == "cssrs_since_contact")
+    return await review(
+        TOKEN,
+        risk.id,
+        ReviewIn(
+            doctor_id="synthetic-doctor", assessment_performed=True, decision="resume", reference="synthetic/assessment"
+        ),
+    )
+
+
+async def test_doctor_review_is_audited_and_unblocks_diary(released):
+    from fastapi import HTTPException
+
+    from app.api.questionnaire import ReviewIn, history, review
+    from app.db.audit import AuditLog
+
+    await complete_intake(released, {"trauma": 1, "tbi": 1, "psychotropics": 1})
+    await jobs.run_until_now()
+    risk = next(r for r in await rows() if r.kind == "cssrs_since_contact")
+    with pytest.raises(HTTPException) as exc:
+        await review(
+            TOKEN,
+            risk.id,
+            ReviewIn(doctor_id="other-doctor", assessment_performed=True, decision="resume", reference="test"),
+        )
+    assert exc.value.status_code == 404
+    await released.handle(TOKEN, Event(type="system", system="doctor_ack"))
+    async with session.get_clinical_session() as s:
+        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())
+    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):
+    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
+
+
+async def test_high_risk_diary_asks_safety_first_and_stops(released):
+    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)
+    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"
+
+
+async def test_unknown_sex_goes_to_review_without_a_zone(released):
+    async with session.get_clinical_session() as s:
+        (await repo.get_profile(s, TOKEN)).sex = None
+    await complete_intake(released, {"trauma": 1, "sex": 2})
+    (row,) = await rows()
+    assert row.status == "review_required" and row.answers["sex"] == "unknown"
+
+
+async def test_version_change_blocks_resume_and_preserves_answers(released):
+    replies = await press(released, "intake:start")
+    await press(released, answer_button(replies))
+    await press(released, "intake:pause")
+    path = get_settings().config_dir / "instruments/intake_forms.yaml"
+    data = yaml.safe_load(path.read_text())
+    data["version"] = "synthetic-next-version"
+    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}
+
+
+async def test_followup_delta_uses_comparable_complete_baseline(released):
+    await complete_intake(released, {"trauma": 1, "phq9_1": 2, "tbi": 1, "psychotropics": 1})
+    async with session.get_clinical_session() as s:
+        task = await service.queue_task(s, TOKEN, "phq9", "synthetic-repeat", NOW)
+        task_id = task.id
+    replies = await released.handle(
+        TOKEN, Event(type="system", system="daily_checkin", params={"questionnaire_task": task_id})
+    )
+    replies = await complete_existing(released, replies, {"phq9_1": 3, "phq9_2": 3, "phq9_3": 1})
+    repeat = next(r for r in await rows() if r.kind == "phq9")
+    assert repeat.status == "complete" and repeat.details["delta"]["value"] == 5
+    assert repeat.details["delta"]["retriage"] is True
+
+
+async def test_silence_uses_completed_checkins_not_empty_records(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
+    monkeypatch.setattr(clock, "now", lambda: NOW + timedelta(days=2))
+    await jobs.plan()
+    await jobs.plan()
+    notices = await rows(QuestionnaireNotice)
+    assert len([n for n in notices if n.event_key.startswith("silence:")]) == 1
+
+
+async def test_stop_any_policy_interrupts_first_positive(released):
+    path = get_settings().config_dir / "questionnaire.yaml"
+    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 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}
+
+
+async def test_evening_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))
+    await jobs.plan()
+    assert await rows(QuestionnaireTask) == []
+    monkeypatch.setattr(clock, "now", lambda: NOW.replace(hour=16, minute=0))
+    await jobs.plan()
+    assert {t.kind for t in await rows(QuestionnaireTask)} == {"diary", "cssrs_since_contact"}
+
+
+async def test_resumed_answer_keeps_original_period(released, monkeypatch):
+    replies = await press(released, "intake:start")
+    await press(released, answer_button(replies))
+    await press(released, "intake:pause")
+    monkeypatch.setattr(clock, "now", lambda: NOW + timedelta(days=1))
+    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"
+    assert metadata["period_end"] == "2026-10-03"
+    assert metadata["answered_at"].startswith("2026-10-04")