Add observation suspecting logic for HCC 48 - Morbid Obesity

dbt_project.yml

@@ -1,5 +1,5 @@
 name: 'the_tuva_project'
-version: '0.7.14'
+version: '0.7.15'
 config-version: 2
 require-dbt-version: ">=1.3.0"
 

models/hcc_suspecting/final/hcc_suspecting__list.sql

@@ -19,7 +19,8 @@ with hcc_history_suspects as (
           end as contributing_factor
         , coalesce(last_billed, last_recorded) as condition_date
     from {{ ref('hcc_suspecting__int_patient_hcc_history') }}
-    where current_year_billed = false
+    where (current_year_billed = false
+        or current_year_billed is null)
 
 )
 
@@ -47,7 +48,36 @@ with hcc_history_suspects as (
           as contributing_factor
         , condition_1_recorded_date as condition_date
     from {{ ref('hcc_suspecting__int_comorbidity_suspects') }}
-    where current_year_billed = false
+    where (current_year_billed = false
+        or current_year_billed is null)
+
+)
+
+, observation_suspects as (
+
+    select distinct
+          patient_id
+        , data_source
+        , hcc_code
+        , hcc_description
+        , cast('Observation suspect' as {{ dbt.type_string() }}) as reason
+        , 'BMI result '
+            || cast(observation_result as {{ dbt.type_string() }})
+            || case
+                when condition_code is null then ''
+                else ' with '
+                    || condition_concept_name
+                    || ' ('
+                    || condition_code
+                    || ' on '
+                    || condition_date
+                    || ')'
+                end
+          as contributing_factor
+        , observation_date as condition_date
+    from {{ ref('hcc_suspecting__int_observation_suspects') }}
+    where (current_year_billed = false
+        or current_year_billed is null)
 
 )
 
@@ -56,6 +86,8 @@ with hcc_history_suspects as (
     select * from hcc_history_suspects
     union all
     select * from comorbidity_suspects
+    union all
+    select * from observation_suspects
 
 )
 

models/hcc_suspecting/hcc_suspecting_models.yml

@@ -132,7 +132,7 @@ models:
       alias: _int_comorbidity_suspects
       tags: hcc_suspecting
       materialized: table
-    description: Comorbidity suspecting conditions.
+    description: Suspecting comorbidities.
     columns:
       - name: patient_id
         description: Unique ID for the patient.
@@ -148,16 +148,61 @@ models:
       - name: hcc_description
         description: >
           HCC description from the latest CMS HCC model available in the mart.
-      - name: reason
-        description: Standardized reason for the suspecting condition.
-      - name: contributing_factor
+      - name: condition_1_concept_name
+        description: Clinical concept name for the first comorbid condition.
+      - name: condition_1_code
+        description: Condition code for the first comorbid condition.
+      - name: condition_1_recorded_date
+        description: Recorded date for the first comorbid condition.
+      - name: condition_2_concept_name
+        description: Clinical concept name for the second comorbid condition.
+      - name: condition_2_code
+        description: Condition code for the second comorbid condition.
+      - name: condition_2_recorded_date
+        description: Recorded date for the second comorbid condition.
+      - name: current_year_billed
         description: >
-          Description of the contributing factor(s) for the suspecting condition.
+          Flag indicating that the HCC has been billed during the payment year.
+      - name: tuva_last_run
+        description: The date the model was run.
+
+  - name: hcc_suspecting__int_observation_suspects
+    config:
+      schema: |
+        {%- if var('tuva_schema_prefix',None) != None -%}{{var('tuva_schema_prefix')}}_hcc_suspecting{% else %}hcc_suspecting{%- endif -%}
+      alias: _int_observation_suspects
+      tags: hcc_suspecting
+      materialized: table
+    description: Suspecting observation conditions.
+    columns:
+      - name: patient_id
+        description: Unique ID for the patient.
+      - name: data_source
+        description: >
+          User-configured field that indicates the data source (e.g. typically 
+          named after the payer and state "BCBS Tennessee").
+      - name: observation_date
+        description: Date the observation was recorded.
+      - name: observation_result
+        description: The result of the observation.
+      - name: condition_code
+        description: The code for the comorbid condition.
       - name: condition_date
-        description: Date when the condition was recorded or billed.
+        description: Recorded date for the condition.
+      - name: condition_concept_name
+        description: Clinical concept name for the comorbid condition.
+      - name: hcc_code
+        description: >
+          HCC code from the latest CMS HCC model available in the mart.
+        meta:
+          terminology: https://github.com/tuva-health/tuva/blob/main/seeds/value_sets/hcc_suspecting/hcc_suspecting__hcc_descriptions.csv
+      - name: hcc_description
+        description: >
+          HCC description from the latest CMS HCC model available in the mart.
       - name: current_year_billed
         description: >
-          Flag indicating that the HCC has been billed during the payment year.
+          Flag indicating that the ICD-10-CM code mapped to the HCC has been
+          billed during the payment year.
       - name: tuva_last_run
         description: The date the model was run.
 
@@ -251,6 +296,21 @@ models:
       - name: code_type
       - name: code
 
+  - name: hcc_suspecting__stg_core__observation
+    config:
+      schema: |
+        {%- if var('tuva_schema_prefix',None) != None -%}{{var('tuva_schema_prefix')}}_hcc_suspecting{% else %}hcc_suspecting{%- endif -%}
+      alias: _stg_observation
+      tags: hcc_suspecting
+      materialized: ephemeral
+    description: Staging observations from core.
+    columns:
+      - name: patient_id
+      - name: observation_date
+      - name: result
+      - name: code_type
+      - name: code
+
   - name: hcc_suspecting__stg_core__patient
     config:
       schema: |