SQL Portfolio: Healthcare Eligibility Rules Engine

Business Problem

A healthcare organization needs to identify patients eligible for a new hypertension management program. Eligibility criteria:

• Diagnosis code I10 (essential hypertension)
• Age 65-75
• Active patient status
• Hospital admission within the last 3 months

What This Demonstrates

1. Eligibility logic implementation — joining patient data to business rules
2. Data quality assessment — identifying missing admission dates
3. Volume troubleshooting — understanding why patient counts change
4. Logic breakdown — showing intermediate steps for validation
5. Near-miss analysis — identifying patients who almost qualify

Files

• schema.sql — Table creation statements
• eligibility_queries.sql — Main eligibility determination
• diagnostic_queries.sql — Data quality and troubleshooting queries

Real-World Applications

This same pattern applies to:

• Clinical trial recruitment
• Prior authorization automation
• Disease surveillance case finding
• Program enrollment determination