Risk scoring updated file

.Net Capstone Project/RiskScoringServiceupdatedcode.cs

@@ -0,0 +1,147 @@
+using ClinicalInsightsPro.API.Data;
+using ClinicalInsightsPro.API.DTOs;
+using ClinicalInsightsPro.API.Models;
+using ClinicalInsightsPro.API.Services.Interfaces;
+using Microsoft.EntityFrameworkCore;
+
+namespace ClinicalInsightsPro.API.Services;
+
+// Questionnaire-based rule engine that scores an encounter as High or Normal
+// risk, combining chart data (conditions, vitals) with clinician-entered
+// questionnaire responses. Rule weights are intentionally simple and modular
+// so they can be extended, or eventually replaced by an ML model, per scope.
+public class RiskScoringService : IRiskScoringService
+{
+    private readonly ApplicationDbContext _db;
+    private const int HighRiskThreshold = 50;
+
+    public RiskScoringService(ApplicationDbContext db)
+    {
+        _db = db;
+    }
+
+    public async Task<RiskAssessmentResultDto> AssessAsync(string patientId, QuestionnaireDto questionnaire)
+    {
+        var patient = await _db.Patients
+            .Include(p => p.Conditions)
+            .Include(p => p.Observations)
+            .Include(p => p.Allergies)
+            .Include(p => p.Medications)
+            .Include(p => p.Encounters)
+            .FirstOrDefaultAsync(p => p.Id == patientId);
+
+        if (patient == null)
+            throw new KeyNotFoundException($"Patient '{patientId}' was not found.");
+
+        int score = 0;
+        var factors = new List<string>();
+
+        foreach (var c in patient.Conditions.Where(c => c.ClinicalStatus == "active"))
+        {
+            switch (c.Code)
+            {
+                case "E11.9":
+                    score += 20; factors.Add("Active Type 2 diabetes (+20)"); break;
+                case "I10":
+                    score += 15; factors.Add("Essential hypertension (+15)"); break;
+                case "J45.909":
+                    score += 10; factors.Add("Asthma (+10)"); break;
+                default:
+                    score += 5; factors.Add($"Active condition: {c.Display} (+5)"); break;
+            }
+        }
+
+        var latestSystolic = patient.Observations
+            .Where(o => o.Code == "8480-6")
+            .OrderByDescending(o => o.EffectiveDate)
+            .FirstOrDefault();
+
+        if (latestSystolic != null && latestSystolic.Value >= 160)
+        {
+            score += 20; factors.Add($"Systolic BP {latestSystolic.Value} mmHg — hypertensive urgency range (+20)");
+        }
+        else if (latestSystolic != null && latestSystolic.Value >= 140)
+        {
+            score += 10; factors.Add($"Systolic BP {latestSystolic.Value} mmHg — stage 2 hypertension (+10)");
+        }
+
+        var latestGlucose = patient.Observations
+            .Where(o => o.Code == "2339-0")
+            .OrderByDescending(o => o.EffectiveDate)
+            .FirstOrDefault();
+
+        if (latestGlucose != null && latestGlucose.Value >= 200)
+        {
+            score += 15; factors.Add($"Glucose {latestGlucose.Value} mg/dL — poorly controlled (+15)");
+        }
+
+        // Allergies — a known high-criticality allergy raises the risk of a
+        // future adverse drug event, independent of what's happening today.
+        var highCriticalityAllergies = patient.Allergies.Count(a => a.Criticality == "high");
+        if (highCriticalityAllergies > 0)
+        {
+            var allergyPoints = Math.Min(highCriticalityAllergies * 10, 20);
+            score += allergyPoints;
+            factors.Add($"{highCriticalityAllergies} high-criticality allerg{(highCriticalityAllergies == 1 ? "y" : "ies")} on file (+{allergyPoints})");
+        }
+
+        // Medications — polypharmacy (commonly defined as 5+ concurrent
+        // medications) is itself an established risk factor for interactions
+        // and adverse events, regardless of what the medications are for.
+        var activeMedicationCount = patient.Medications.Count(m => m.Status == "active");
+        if (activeMedicationCount >= 5)
+        {
+            score += 12; factors.Add($"Polypharmacy — {activeMedicationCount} active medications (+12)");
+        }
+        else if (activeMedicationCount >= 3)
+        {
+            score += 6; factors.Add($"{activeMedicationCount} active medications (+6)");
+        }
+
+        // Encounters — frequent recent encounters (visits, admissions, ED
+        // visits) in the last 12 months suggest an unstable or worsening
+        // condition even if no single encounter looks alarming on its own.
+        var recentEncounterCount = patient.Encounters.Count(e => e.EncounterDate >= DateTime.UtcNow.AddMonths(-12));
+        if (recentEncounterCount >= 3)
+        {
+            score += 12; factors.Add($"{recentEncounterCount} encounters within the last 12 months (+12)");
+        }
+        else if (recentEncounterCount == 2)
+        {
+            score += 6; factors.Add("2 encounters within the last 12 months (+6)");
+        }
+
+        if (questionnaire.Smoker) { score += 10; factors.Add("Current smoker (+10)"); }
+        if (questionnaire.FamilyHistoryHeartDisease) { score += 8; factors.Add("Family history of heart disease (+8)"); }
+        if (questionnaire.PriorHospitalization) { score += 12; factors.Add("Prior hospitalization within 12 months (+12)"); }
+        if (questionnaire.Bmi is >= 30) { score += 8; factors.Add($"BMI {questionnaire.Bmi:F1} — obese range (+8)"); }
+        if (questionnaire.PainScore >= 7) { score += 5; factors.Add($"Reported pain score {questionnaire.PainScore}/10 (+5)"); }
+
+        score = Math.Min(score, 100);
+        var level = score >= HighRiskThreshold ? "High" : "Normal";
+
+        if (!factors.Any())
+            factors.Add("No significant risk factors identified from chart or questionnaire.");
+
+        var assessment = new RiskAssessment
+        {
+            PatientId = patientId,
+            Score = score,
+            RiskLevel = level,
+            Rationale = string.Join("; ", factors),
+            AssessedDate = DateTime.UtcNow
+        };
+
+        _db.RiskAssessments.Add(assessment);
+        await _db.SaveChangesAsync();
+
+        return new RiskAssessmentResultDto
+        {
+            PatientId = patientId,
+            Score = score,
+            RiskLevel = level,
+            ContributingFactors = factors,
+            AssessedDate = assessment.AssessedDate
+        };
+    }
+}