Initial commit: HealthCarePregnant project documentation and platform
Co-Authored-By: Claude <noreply@anthropic.com>
This commit is contained in:
selfrelease
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/**
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* 端到端场景演练（T-9.2 / PRD §3.2 核心场景 S1–S7、§5.1 闭环、§7 上线判据）。
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*
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* 在服务层串联各模块，覆盖 V1 可上线场景的实质闭环；
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* 标注为 V2/V3 的能力（趋势预测、游戏化）以 it.todo 记录，不在 V1 断言。
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*
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* 复用既有内存仓储与服务，构造共享依赖的系统实例（makeSystem）。
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*/
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import { PatientService } from '../modules/patient/patient.service';
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import { InMemoryPatientRepository } from '../modules/patient/patient.repository';
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import { AnalysisService } from '../modules/analysis/analysis.service';
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import { InMemoryAlertRepository } from '../modules/analysis/alert.repository';
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import { CaseflowService } from '../modules/caseflow/caseflow.service';
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import { InMemoryCaseflowRepository } from '../modules/caseflow/caseflow.repository';
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import { ObservationService } from '../modules/observation/observation.service';
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import { InMemoryObservationRepository } from '../modules/observation/observation.repository';
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import { KnowledgeService } from '../modules/knowledge/knowledge.service';
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import { InMemoryKnowledgeRepository } from '../modules/knowledge/knowledge.repository';
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import { AiService } from '../modules/ai/ai.service';
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import { NotificationService } from '../modules/notification/notification.service';
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import { RedflagService } from '../modules/redflag/redflag.service';
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import { ReminderService } from '../modules/reminder/reminder.service';
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import { FollowupService } from '../modules/followup/followup.service';
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import { InMemoryFollowupRepository } from '../modules/followup/followup.repository';
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function makeSystem() {
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const notification = new NotificationService();
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const followupService = new FollowupService(new InMemoryFollowupRepository());
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const patientService = new PatientService(new InMemoryPatientRepository());
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const analysisService = new AnalysisService(new InMemoryAlertRepository());
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const caseflowService = new CaseflowService(new InMemoryCaseflowRepository());
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const observationService = new ObservationService(
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new InMemoryObservationRepository(),
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patientService,
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analysisService,
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caseflowService,
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followupService,
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);
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const knowledgeService = new KnowledgeService(new InMemoryKnowledgeRepository());
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const aiService = new AiService(knowledgeService, analysisService, caseflowService);
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const redflagService = new RedflagService(notification, caseflowService);
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const reminderService = new ReminderService(patientService, notification);
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return {
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notification,
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patientService,
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analysisService,
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caseflowService,
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observationService,
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knowledgeService,
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aiService,
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redflagService,
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reminderService,
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};
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}
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describe('PRD §3.2 核心场景端到端演练（T-9.2）', () => {
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describe('S1 居家测血糖/血压后自动分析（REQ-1/3）', () => {
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it('血糖录入 → 质控通过 → 规则分析 → 可追溯预警', async () => {
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const sys = makeSystem();
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const patient = await sys.patientService.create({ name: '小雅', age: 30, lmp: '2026-01-01' });
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const rec = await sys.observationService.record(patient.id, {
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indicator: 'fasting_glucose',
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value: 5.6,
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});
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expect(rec.observation.qcStatus).toBe('accepted');
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expect(rec.alert).not.toBeNull();
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expect(rec.alert?.level).toBe('medium');
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// 可解释 / 可追溯（NFR-3）：命中规则 + 关联观测值
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expect(rec.alert?.ruleIds.length).toBeGreaterThan(0);
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expect(rec.alert?.observationId).toBe(rec.observation.id);
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});
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it('血压录入 → 升高生成预警', async () => {
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const sys = makeSystem();
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const patient = await sys.patientService.create({ name: '小雅', age: 30, lmp: '2026-01-01' });
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const rec = await sys.observationService.record(patient.id, {
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indicator: 'systolic_bp',
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value: 150,
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});
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expect(rec.observation.qcStatus).toBe('accepted');
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expect(rec.alert?.level).toBe('medium');
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});
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it('不可信数值 → 质控拦截，不驱动高风险结论（C-5）', async () => {
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const sys = makeSystem();
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const patient = await sys.patientService.create({ name: '小雅', age: 30, lmp: '2026-01-01' });
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const rec = await sys.observationService.record(patient.id, {
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indicator: 'fasting_glucose',
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value: 50, // 超出生理合理范围
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});
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expect(rec.observation.qcStatus).toBe('rejected');
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expect(rec.alert).toBeNull();
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});
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});
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describe('S2 GDM 风险孕妇的日常管理闭环（REQ-6/9/10）', () => {
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it('建档→预警→自动开案→指派→流转→AI建议(需人工确认)→照护计划→提醒', async () => {
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const sys = makeSystem();
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// 既往 GDM → 基线 medium
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const patient = await sys.patientService.create({
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name: '小雅',
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age: 31,
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lmp: '2026-01-01',
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historyGdm: true,
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});
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expect(patient.initialRiskLevel).toBe('medium');
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// 录入偏高血糖 → 预警 → 预警驱动开案
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const rec = await sys.observationService.record(patient.id, {
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indicator: 'fasting_glucose',
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value: 6.2,
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});
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expect(rec.alert).not.toBeNull();
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const c = await sys.caseflowService.getCaseByPatient(patient.id);
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expect(c.status).toBe('open');
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expect(c.riskLevel).toBe('medium');
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// 指派管理师 + 推进阶段
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await sys.caseflowService.assignManager(c.id, 'cm-1');
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const advanced = await sys.caseflowService.advanceStage(c.id, 'assessment', '评估');
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expect(advanced.stage).toBe('assessment');
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expect(advanced.caseManagerId).toBe('cm-1');
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// AI 决策建议：中风险 → 必须人工确认（REQ-10.3）
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const reco = await sys.aiService.recommendForPatient(patient.id);
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expect(reco.requiresHumanConfirmation).toBe(true);
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expect(reco.actions.length).toBeGreaterThan(0);
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// 照护计划
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const plan = await sys.caseflowService.createCarePlan(c.id, {
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goals: ['空腹血糖 < 5.1 mmol/L'],
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interventions: [{ kind: 'lifestyle', description: '饮食控制 + 餐后散步' }],
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followUpFrequency: 'weekly',
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});
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expect(plan.goals.length).toBe(1);
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// 提醒下发
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const reminder = await sys.reminderService.dispatch({ patientId: patient.id, type: 'measurement' });
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expect(reminder.effectiveType).toBe('measurement');
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expect(sys.notification.findByRecipient(patient.id).length).toBeGreaterThan(0);
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});
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});
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describe('S3 子痫前期红旗症状旁路（REQ-5）', () => {
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it('危急组合 → 即时就医提示 + 通知管理师/医生 + 升级高风险', async () => {
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const sys = makeSystem();
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const patient = await sys.patientService.create({ name: '小雅', age: 30, lmp: '2026-01-01' });
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const result = await sys.redflagService.evaluate(patient.id, {
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systolicBp: 165,
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diastolicBp: 112,
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symptoms: ['severe_headache'],
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});
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expect(result.triggered).toBe(true);
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expect(result.hits.map((h) => h.ruleId)).toContain('RF-PREECLAMPSIA');
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expect(result.patientAdvice).toContain('就医');
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// 通知：孕妇 + 管理师 + 医生，均为紧急
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const msgs = sys.notification.findByRecipient(patient.id);
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const audiences = msgs.filter((m) => m.urgent).map((m) => m.audience);
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expect(audiences).toEqual(expect.arrayContaining(['patient', 'case_manager', 'physician']));
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// 个案升级为高风险
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const c = await sys.caseflowService.getCaseByPatient(patient.id);
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expect(c.riskLevel).toBe('high');
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});
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});
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describe('S4 深夜疑问"我能吃这个吗"（REQ-7）', () => {
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it('命中知识 → 带溯源作答；无依据 → 不超纲并建议就医', async () => {
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const sys = makeSystem();
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await sys.knowledgeService.create({
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category: 'guideline',
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title: '孕期饮食与血糖',
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content: '控制精制碳水、少量多餐；水果适量并计入总量。',
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keywords: ['饮食', '血糖', '水果', '能吃'],
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source: '某权威指南',
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authority: 'authoritative',
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});
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const grounded = await sys.aiService.ask('孕期能吃水果吗');
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expect(grounded.grounded).toBe(true);
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expect(grounded.citations.length).toBeGreaterThan(0);
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expect(grounded.citations[0].source).toBe('某权威指南');
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const ungrounded = await sys.aiService.ask('明天会下雨吗');
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expect(ungrounded.grounded).toBe(false);
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expect(ungrounded.citations).toHaveLength(0);
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});
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});
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describe('S5 趋势预警/预测（REQ-3.5/4）', () => {
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it('纵向观测按孕周累积，构成趋势分析的数据基础', async () => {
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const sys = makeSystem();
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const patient = await sys.patientService.create({ name: '小雅', age: 30, lmp: '2026-01-01' });
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await sys.observationService.record(patient.id, { indicator: 'fasting_glucose', value: 4.8 });
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await sys.observationService.record(patient.id, { indicator: 'fasting_glucose', value: 5.0 });
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const series = await sys.observationService.list(patient.id);
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expect(series.length).toBe(2);
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// 每条带孕周上下文，支撑后续时序趋势
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expect(series.every((o) => typeof o.gestationalWeeks === 'number')).toBe(true);
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});
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// 趋势异常检测（REQ-3.5，V2）与预测模型（REQ-4，V3，需回顾性+前瞻性验证）超出 V1 范围
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it.todo('S5 时序趋势异常检测（REQ-3.5）为 V2');
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it.todo('S5 趋势预测模型（REQ-4）为 V3，需经验证');
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});
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describe('S6 提升坚持度、缓解焦虑（REQ-9）', () => {
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it('高风险孕妇运动提醒自动替换为休息（REQ-9.2 安全约束）', async () => {
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const sys = makeSystem();
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// 多胎 + 既往GDM → score 4 → 基线高风险
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const patient = await sys.patientService.create({
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name: '小雅',
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age: 31,
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lmp: '2026-01-01',
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multipleGestation: true,
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historyGdm: true,
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});
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expect(patient.initialRiskLevel).toBe('high');
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const reminder = await sys.reminderService.dispatch({ patientId: patient.id, type: 'exercise' });
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expect(reminder.effectiveType).toBe('rest');
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expect(reminder.adjustedForRisk).toBe(true);
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});
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it('非高风险孕妇运动提醒保持运动', async () => {
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const sys = makeSystem();
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const patient = await sys.patientService.create({ name: '小雅', age: 28, lmp: '2026-01-01' });
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const reminder = await sys.reminderService.dispatch({ patientId: patient.id, type: 'exercise' });
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expect(reminder.effectiveType).toBe('exercise');
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expect(reminder.adjustedForRisk).toBe(false);
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});
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// 游戏化（积分/徽章/小游戏，REQ-9.3/9.4）为 V2
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it.todo('S6 游戏化激励（REQ-9.3/9.4）为 V2');
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});
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describe('S7 管理师 PC 端批量管理（REQ-13.3）', () => {
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it('多名孕妇入列，提供风险分层作为工作台排序依据', async () => {
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const sys = makeSystem();
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await sys.patientService.create({ name: '低风险', age: 28, lmp: '2026-01-01' });
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await sys.patientService.create({ name: '中风险', age: 31, lmp: '2026-01-01', historyGdm: true });
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await sys.patientService.create({
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name: '高风险',
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age: 36,
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lmp: '2026-01-01',
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multipleGestation: true,
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historyPih: true,
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});
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const list = await sys.patientService.list();
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expect(list.length).toBe(3);
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// 每名孕妇均带初始风险分层（admin-web 工作列表据此按 高→中→低 排序）
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const levels = list.map((p) => p.initialRiskLevel).sort();
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expect(levels).toEqual(['high', 'low', 'medium']);
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});
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});
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});
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