isaacclad
2ce4bc8993
Deploy Ladill Care / deploy (push) Successful in 1m26s
Add a template-driven assessment system with universal intake, clinical pathways, disease instruments (stroke MVP + extended, diabetes, and ten specialty packs), scoring, patient outcome trends, REST/API + FHIR export, and Enterprise org-level assessment analytics. Seed packs and design/licensing docs ship for deploy and pre-GA review.
290 lines
10 KiB
PHP
290 lines
10 KiB
PHP
<?php
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namespace Tests\Feature;
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use App\Http\Middleware\EnsurePlatformSession;
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use App\Models\Assessment;
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use App\Models\AssessmentScore;
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use App\Models\AssessmentTemplate;
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use App\Models\Branch;
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use App\Models\ClinicalPathway;
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use App\Models\Consultation;
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use App\Models\Diagnosis;
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use App\Models\Member;
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use App\Models\Organization;
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use App\Models\Patient;
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use App\Models\PatientPathway;
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use App\Models\User;
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use App\Models\Visit;
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use App\Services\Care\CareFeatures;
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use App\Services\Care\ScoringService;
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use Database\Seeders\AssessmentTemplateSeeder;
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use Database\Seeders\ClinicalPathwaySeeder;
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use Illuminate\Foundation\Testing\RefreshDatabase;
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use Illuminate\Support\Str;
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use Tests\TestCase;
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/**
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* PR 6 — Stroke MVP content packs (NIHSS + mRS) and M2 vertical slice.
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*/
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class CareStrokeMvpTest extends TestCase
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{
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use RefreshDatabase;
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protected User $user;
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protected Organization $organization;
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protected Branch $branch;
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protected Patient $patient;
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protected Member $member;
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protected function setUp(): void
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{
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parent::setUp();
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$this->withoutMiddleware(EnsurePlatformSession::class);
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$this->user = User::create([
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'public_id' => 'stroke-mvp-user',
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'name' => 'Stroke MVP',
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'email' => 'stroke@example.com',
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]);
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$this->organization = Organization::create([
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'owner_ref' => $this->user->public_id,
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'name' => 'Stroke Clinic',
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'slug' => 'stroke-clinic',
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'timezone' => 'UTC',
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'settings' => [
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'onboarded' => true,
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'rollout' => [CareFeatures::ASSESSMENTS_ENGINE => true],
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],
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]);
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$this->member = Member::create([
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'owner_ref' => $this->user->public_id,
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'organization_id' => $this->organization->id,
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'user_ref' => $this->user->public_id,
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'role' => 'doctor',
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]);
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$this->branch = Branch::create([
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'owner_ref' => $this->user->public_id,
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'organization_id' => $this->organization->id,
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'name' => 'Main',
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'is_active' => true,
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]);
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$this->patient = Patient::create([
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'uuid' => (string) Str::uuid(),
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'owner_ref' => $this->user->public_id,
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'organization_id' => $this->organization->id,
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'branch_id' => $this->branch->id,
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'patient_number' => 'LC-STROKE-001',
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'first_name' => 'Efua',
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'last_name' => 'Asante',
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]);
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$this->seed(AssessmentTemplateSeeder::class);
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$this->seed(ClinicalPathwaySeeder::class);
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}
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public function test_seed_packs_load_nihss_and_mrs(): void
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{
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$nihss = AssessmentTemplate::currentSystemByCode('nihss');
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$mrs = AssessmentTemplate::currentSystemByCode('mrs');
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$this->assertNotNull($nihss);
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$this->assertNotNull($mrs);
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$this->assertSame('sum_items', $nihss->scoring_strategy);
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$this->assertSame('single_value', $mrs->scoring_strategy);
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$this->assertSame(15, $nihss->questions()->count());
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$this->assertSame(1, $mrs->questions()->count());
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$this->assertSame(['doctor'], $nihss->meta['capture_roles'] ?? null);
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$pathway = ClinicalPathway::findByCode('stroke');
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$this->assertNotNull($pathway);
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$codes = $pathway->templates()->pluck('template_code')->all();
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$this->assertContains('nihss', $codes);
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$this->assertContains('mrs', $codes);
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$required = $pathway->templates()->where('is_required_on_activation', true)->pluck('template_code')->all();
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$this->assertEqualsCanonicalizing(['nihss', 'mrs'], $required);
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}
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public function test_golden_mrs_score_three(): void
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{
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$this->actingAs($this->user)
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->post(route('care.assessments.store', $this->patient), ['template_code' => 'mrs'])
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->assertRedirect();
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$assessment = Assessment::first();
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$this->actingAs($this->user)
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->put(route('care.assessments.update', $assessment), [
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'answers' => ['mrs_score' => '3'],
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])
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->assertRedirect();
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$this->actingAs($this->user)
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->post(route('care.assessments.complete', $assessment))
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->assertRedirect();
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$score = AssessmentScore::where('assessment_id', $assessment->id)->first();
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$this->assertNotNull($score);
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$this->assertEquals(3, (float) $score->total_score);
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$this->assertEquals(6, (float) $score->max_score);
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$this->assertSame('mrs', $score->template_code);
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}
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public function test_golden_nihss_fixture_total_twelve_max_forty_two(): void
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{
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// Moderate left hemisphere pattern → total 12; max 42.
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$answers = [
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'1a_loc' => '1',
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'1b_loc_questions' => '1',
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'1c_loc_commands' => '0',
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'2_gaze' => '0',
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'3_visual' => '1',
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'4_facial' => '2',
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'5a_motor_arm_left' => '2',
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'5b_motor_arm_right' => '0',
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'6a_motor_leg_left' => '2',
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'6b_motor_leg_right' => '0',
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'7_ataxia' => '0',
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'8_sensory' => '1',
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'9_language' => '1',
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'10_dysarthria' => '1',
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'11_extinction' => '0',
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];
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// 1+1+0+0+1+2+2+0+2+0+0+1+1+1+0 = 12
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$this->actingAs($this->user)
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->post(route('care.assessments.store', $this->patient), ['template_code' => 'nihss'])
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->assertRedirect();
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$assessment = Assessment::first();
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$this->actingAs($this->user)
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->put(route('care.assessments.update', $assessment), ['answers' => $answers])
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->assertRedirect();
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$preview = app(ScoringService::class)->preview(
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$assessment->fresh(['template.questions', 'answers.question'])
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);
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$this->assertEquals(12.0, $preview['total']);
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$this->assertEquals(42.0, $preview['max']);
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$this->actingAs($this->user)
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->post(route('care.assessments.complete', $assessment))
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->assertRedirect();
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$score = AssessmentScore::first();
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$this->assertEquals(12, (float) $score->total_score);
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$this->assertEquals(42, (float) $score->max_score);
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$this->assertArrayHasKey('loc', $score->subscores);
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$this->assertEquals(2.0, (float) $score->subscores['loc']); // 1a+1b+1c = 2
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}
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public function test_m2_e2e_activate_stroke_complete_nihss_and_mrs(): void
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{
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$visit = Visit::create([
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'owner_ref' => $this->user->public_id,
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'organization_id' => $this->organization->id,
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'branch_id' => $this->branch->id,
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'patient_id' => $this->patient->id,
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'status' => Visit::STATUS_OPEN,
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'checked_in_at' => now(),
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]);
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$consultation = Consultation::create([
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'owner_ref' => $this->user->public_id,
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'visit_id' => $visit->id,
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'patient_id' => $this->patient->id,
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'status' => Consultation::STATUS_DRAFT,
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'started_at' => now(),
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]);
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Diagnosis::create([
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'owner_ref' => $this->user->public_id,
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'consultation_id' => $consultation->id,
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'code' => 'I63.9',
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'description' => 'Cerebral infarction, unspecified',
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'is_primary' => true,
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]);
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$this->actingAs($this->user)
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->get(route('care.consultations.show', $consultation))
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->assertOk()
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->assertSee('Stroke')
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->assertSee('Activate');
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$this->actingAs($this->user)
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->post(route('care.pathways.store', $this->patient), [
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'pathway_code' => 'stroke',
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'consultation_uuid' => $consultation->uuid,
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])
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->assertRedirect();
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$this->assertSame(1, PatientPathway::where('status', PatientPathway::STATUS_ACTIVE)->count());
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$this->assertSame(2, Assessment::where('status', Assessment::STATUS_DRAFT)->count());
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$this->actingAs($this->user)
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->get(route('care.consultations.show', $consultation))
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->assertOk()
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->assertSee('Pathway instruments')
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->assertSee('NIH Stroke Scale')
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->assertSee('Modified Rankin Scale')
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->assertSee('Continue');
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$nihss = Assessment::query()
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->whereHas('template', fn ($q) => $q->where('code', 'nihss'))
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->first();
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$mrs = Assessment::query()
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->whereHas('template', fn ($q) => $q->where('code', 'mrs'))
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->first();
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$this->assertNotNull($nihss);
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$this->assertNotNull($mrs);
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$this->assertSame($consultation->id, $nihss->consultation_id);
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// Minimal valid NIHSS (all zeros) → total 0.
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$zeroAnswers = collect($nihss->template->questions)->mapWithKeys(
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fn ($q) => [$q->code => '0']
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)->all();
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$this->actingAs($this->user)
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->put(route('care.assessments.update', $nihss), ['answers' => $zeroAnswers])
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->assertRedirect();
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$this->actingAs($this->user)
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->post(route('care.assessments.complete', $nihss))
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->assertRedirect();
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$this->assertEquals(0, (float) AssessmentScore::where('assessment_id', $nihss->id)->value('total_score'));
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$this->assertEquals(42, (float) AssessmentScore::where('assessment_id', $nihss->id)->value('max_score'));
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$this->actingAs($this->user)
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->put(route('care.assessments.update', $mrs), ['answers' => ['mrs_score' => '2']])
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->assertRedirect();
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$this->actingAs($this->user)
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->post(route('care.assessments.complete', $mrs))
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->assertRedirect();
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$this->assertEquals(2, (float) AssessmentScore::where('assessment_id', $mrs->id)->value('total_score'));
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$this->actingAs($this->user)
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->get(route('care.consultations.show', $consultation))
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->assertOk()
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->assertSee('score 0')
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->assertSee('score 2');
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}
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public function test_nurse_cannot_start_seeded_nihss(): void
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{
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$this->member->update(['role' => 'nurse']);
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$this->actingAs($this->user)
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->post(route('care.assessments.store', $this->patient), ['template_code' => 'nihss'])
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->assertForbidden();
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}
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}
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