feat: dp_finalizer — arbitrage Trackare vs CRH-only avec traçabilité audit
Nouveau module src/medical/dp_finalizer.py : - 5 règles d'arbitrage (R1-R5) : CRH CONFIRMED override, Trackare corroboré, symptôme R* override/review, ambigu REVIEW, Z-code/R-code interdits auto-confirm - Traçabilité : dp_trackare, dp_crh_only, dp_final sur DossierMedical - quality_flags dict (merge sans écraser) + alertes_codage (append) Modèles config.py : - DPCandidate, DPSelection (NUKE-3) - get_dp_ranker_llm_enabled(), check_adversarial_model_config() - Champs DossierMedical : dp_trackare, dp_crh_only, dp_final, quality_flags Intégration : - main.py : appel finalize_dp() après vetos/GHM (individuel + fusionné) - benchmark : finalizer dans _rebuild_and_select(), dp_final dans output Co-Authored-By: Claude Opus 4.6 <noreply@anthropic.com>
This commit is contained in:
dom
@@ -68,6 +68,52 @@ def get_model(role: str) -> str:
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return OLLAMA_MODELS.get(role, OLLAMA_MODEL)
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# --- Flag LLM pour le sélecteur DP (NUKE-3) ---
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# Nom canonique : T2A_DP_RANKER_LLM (0/1)
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# Ancien nom accepté (compat) : DP_RANKER_LLM_ENABLED
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DP_RANKER_LLM_ENABLED = os.environ.get("T2A_DP_RANKER_LLM", "1").lower() in ("1", "true", "yes")
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def get_dp_ranker_llm_enabled() -> bool:
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"""Retourne l'état du flag LLM pour NUKE-3 (lecture fraîche de l'env).
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Nom canonique : T2A_DP_RANKER_LLM (0/1/true/false/yes/no).
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Accepte aussi l'ancien nom DP_RANKER_LLM_ENABLED avec warning.
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"""
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canonical = os.environ.get("T2A_DP_RANKER_LLM")
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legacy = os.environ.get("DP_RANKER_LLM_ENABLED")
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if canonical is not None:
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return canonical.lower() in ("1", "true", "yes")
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if legacy is not None:
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import logging as _logging
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_logging.getLogger(__name__).warning(
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"Env var DP_RANKER_LLM_ENABLED est dépréciée — utiliser T2A_DP_RANKER_LLM"
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)
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return legacy.lower() in ("1", "true", "yes")
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# Défaut : activé
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return True
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def check_adversarial_model_config() -> tuple[bool, str]:
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"""LOGIC-3 — Vérifie si les modèles CPAM et validation sont identiques.
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Returns:
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(same_model, warning_message)
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"""
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cpam = OLLAMA_MODELS.get("cpam", "")
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validation = OLLAMA_MODELS.get("validation", "")
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if cpam and validation and cpam == validation:
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msg = (
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f"Modèles CPAM et validation identiques ({cpam}) "
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"— validation adversariale dégradée"
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)
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return True, msg
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return False, ""
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# --- Configuration RUM / établissement ---
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FINESS = os.environ.get("T2A_FINESS", "000000000")
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@@ -553,6 +599,37 @@ class CodeDecision(BaseModel):
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applied_rules: list[str] = Field(default_factory=list)
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class DPCandidate(BaseModel):
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"""Candidat DP pour la sélection NUKE-3."""
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index: int
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term: str
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code: Optional[str] = None
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confidence: Optional[str] = None
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source: Optional[str] = None
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is_comorbidity_like: bool = False
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is_symptom_like: bool = False
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is_act_only: bool = False
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section_strength: int = 0
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num_occurrences: int = 1
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score: float = 0.0
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score_details: dict = Field(default_factory=dict)
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class DPSelection(BaseModel):
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"""Résultat de la sélection NUKE-3 du DP."""
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chosen_index: Optional[int] = None
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chosen_term: Optional[str] = None
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chosen_code: Optional[str] = None
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confidence: Optional[str] = None
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verdict: str = "REVIEW" # CONFIRMED | REVIEW
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evidence: list[str] = Field(default_factory=list)
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reason: Optional[str] = None
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candidates: list[DPCandidate] = Field(default_factory=list)
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debug_scores: Optional[dict] = None
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class Diagnostic(BaseModel):
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texte: str
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cim10_suggestion: Optional[str] = None
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@@ -656,6 +733,12 @@ class DossierMedical(BaseModel):
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document_type: str = ""
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sejour: Sejour = Field(default_factory=Sejour)
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diagnostic_principal: Optional[Diagnostic] = None
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dp_selection: Optional[DPSelection] = None
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# Traçabilité DP (finalizer) — audit DIM
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dp_trackare: Optional[DPSelection] = None # DP issu du Trackare (si existant)
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dp_crh_only: Optional[DPSelection] = None # DP issu du CRH-only pipeline
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dp_final: Optional[DPSelection] = None # DP final après arbitrage finalizer
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quality_flags: dict = Field(default_factory=dict)
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diagnostics_associes: list[Diagnostic] = Field(default_factory=list)
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actes_ccam: list[ActeCCAM] = Field(default_factory=list)
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antecedents: list[Antecedent] = Field(default_factory=list)
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14
src/main.py
14
src/main.py
@@ -262,6 +262,13 @@ def process_pdf(pdf_path: Path) -> list[tuple[str, DossierMedical, Anonymization
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except Exception:
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logger.warning(" Erreur estimation GHM/metrics", exc_info=True)
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# 10. Finalizer DP (arbitrage Trackare vs CRH, traçabilité)
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try:
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from .medical.dp_finalizer import finalize_dp
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finalize_dp(dossier)
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except Exception:
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logger.warning(" Finalizer DP : erreur", exc_info=True)
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dossier.processing_time_s = round(time.time() - t0, 2)
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results.append((anonymized_text, dossier, report))
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@@ -629,6 +636,13 @@ def main(input_path: str | None = None) -> None:
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except Exception:
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logger.warning(" Erreur estimation GHM/metrics final", exc_info=True)
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# Finalizer DP (arbitrage Trackare vs CRH, traçabilité)
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try:
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from .medical.dp_finalizer import finalize_dp
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finalize_dp(merged)
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except Exception:
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logger.warning(" Finalizer DP fusionné : erreur", exc_info=True)
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struct_dir = STRUCTURED_DIR / subdir
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struct_dir.mkdir(parents=True, exist_ok=True)
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merged_path = struct_dir / f"{subdir}_fusionne_cim10.json"
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335
src/medical/dp_finalizer.py
Normal file
335
src/medical/dp_finalizer.py
Normal file
@@ -0,0 +1,335 @@
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"""DP Finalizer — arbitrage Trackare vs CRH-only.
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Dernière étape du pipeline DP : produit ``dp_final`` avec traçabilité
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complète (``dp_trackare``, ``dp_crh_only``) et ``quality_flags`` audit.
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Principes :
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- Clean architecture : logique métier isolée, pas de dépendance Ollama.
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- Traçabilité : chaque décision est justifiée (reason + evidence + flags).
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- Prudence : en cas de doute → REVIEW, jamais CONFIRMED.
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"""
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from __future__ import annotations
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from src.config import DossierMedical, DPSelection
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# Whitelist Z-codes admis en DP CONFIRMED (même que dp_selector)
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_Z_CODE_DP_WHITELIST = frozenset({
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"Z03", "Z04", "Z08", "Z09",
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"Z38", "Z43", "Z45", "Z50", "Z51", "Z54", "Z75",
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"Z99",
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})
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def _family3(code: str | None) -> str:
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"""Extrait le préfixe 3 caractères (family3) d'un code CIM-10."""
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if not code:
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return ""
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return code.split(".")[0].upper()
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def _code_in_candidates(code: str | None, selection: DPSelection) -> bool:
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"""Vérifie si *code* apparaît dans les candidats de *selection* (exact ou family3)."""
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if not code or not selection.candidates:
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return False
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code_up = code.upper()
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fam = _family3(code)
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for c in selection.candidates:
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c_code = (c.code or "").upper()
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if c_code == code_up or _family3(c_code) == fam:
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return True
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return False
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def _has_strong_evidence(sel: DPSelection) -> bool:
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"""Vérifie si la sélection a une evidence forte (non triviale)."""
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if not sel.evidence:
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return False
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# "Source: Trackare" seul n'est pas une preuve forte
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strong = [e for e in sel.evidence if "Trackare" not in e]
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return len(strong) > 0
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def _make_selection(
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code: str | None,
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term: str | None,
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verdict: str,
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confidence: str,
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evidence: list[str],
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reason: str,
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source_sel: DPSelection | None = None,
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) -> DPSelection:
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"""Construit un DPSelection final en préservant les candidats de la source."""
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return DPSelection(
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chosen_code=code,
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chosen_term=term,
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verdict=verdict,
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confidence=confidence,
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evidence=evidence,
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reason=reason,
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candidates=source_sel.candidates if source_sel else [],
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debug_scores=source_sel.debug_scores if source_sel else None,
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chosen_index=source_sel.chosen_index if source_sel else None,
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)
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# ── Règles R1-R5 ──────────────────────────────────────────────────────
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def decide_dp_final(
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trackare_dp: DPSelection | None,
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crh_dp: DPSelection | None,
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allow_symptom_dp: bool = False,
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) -> tuple[DPSelection, dict, list[str]]:
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"""Arbitrage Trackare vs CRH-only.
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Returns:
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(dp_final, quality_flags_additions, alertes)
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"""
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flags: dict = {}
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alertes: list[str] = []
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# ── Cas dégénérés ──────────────────────────────────────────────
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if not trackare_dp and not crh_dp:
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return (
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DPSelection(verdict="REVIEW", reason="Aucun DP disponible"),
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{"no_dp_source": True},
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["Aucun DP extrait (ni Trackare ni CRH)"],
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)
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if not trackare_dp and crh_dp:
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# CRH-only mode — pass-through
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dp = crh_dp.model_copy(deep=True)
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flags["crh_only_mode"] = True
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# Appliquer R5 post-hoc
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dp, r5_flags, r5_alertes = _apply_r5(dp, crh_dp, allow_symptom_dp)
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flags.update(r5_flags)
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alertes.extend(r5_alertes)
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return dp, flags, alertes
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if trackare_dp and not crh_dp:
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# Trackare-only mode
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code = trackare_dp.chosen_code or ""
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# R5 : Z-code → REVIEW
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if code.startswith("Z") and _family3(code) not in _Z_CODE_DP_WHITELIST:
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dp = _make_selection(
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code=trackare_dp.chosen_code,
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term=trackare_dp.chosen_term,
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verdict="REVIEW",
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confidence="medium",
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evidence=trackare_dp.evidence + ["Z-code en DP : vérification DIM requise"],
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reason="R5 — Z-code non whitelisté en DP",
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source_sel=trackare_dp,
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)
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flags["trackare_only_mode"] = True
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flags["z_code_dp_review"] = True
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return dp, flags, ["DP Trackare Z-code non whitelisté → REVIEW"]
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dp = trackare_dp.model_copy(deep=True)
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# Respecter un REVIEW déjà posé par le garde-fou dp_selector
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if not dp.evidence:
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dp.evidence = ["Source: Trackare (codage établissement)"]
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flags["trackare_only_mode"] = True
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return dp, flags, alertes
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# ── Les deux sources existent ──────────────────────────────────
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assert trackare_dp is not None and crh_dp is not None
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t_code = (trackare_dp.chosen_code or "").upper()
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c_code = (crh_dp.chosen_code or "").upper()
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t_fam = _family3(t_code)
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c_fam = _family3(c_code)
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# ── R3 — Trackare symptôme (R*) + CRH étiologique ─────────────
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# (évalué avant R1 : cas spécifique > cas général)
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if t_code.startswith("R"):
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if crh_dp.verdict == "CONFIRMED" and not c_code.startswith("R") and _has_strong_evidence(crh_dp):
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# Override : CRH étiologique CONFIRMED
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dp = crh_dp.model_copy(deep=True)
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dp.reason = "R3 — Trackare symptôme écarté au profit du CRH étiologique CONFIRMED"
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flags["trackare_symptom_overridden"] = True
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alertes.append(
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f"Trackare symptôme ({t_code}) remplacé par CRH ({c_code}) — "
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f"diagnostic étiologique CONFIRMED"
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)
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# R5 post-hoc
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dp, r5_flags, r5_alertes = _apply_r5(dp, crh_dp, allow_symptom_dp)
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flags.update(r5_flags)
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alertes.extend(r5_alertes)
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return dp, flags, alertes
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else:
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# REVIEW prudent
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dp = _make_selection(
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code=trackare_dp.chosen_code,
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term=trackare_dp.chosen_term,
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verdict="REVIEW",
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confidence="medium",
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evidence=[
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"Source: Trackare (codage établissement)",
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"Alerte: Trackare code un symptôme (R*) mais le CRH mentionne un diagnostic étiologique",
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],
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reason="R3 — Trackare symptôme vs CRH diagnostic : vérification DIM requise",
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source_sel=trackare_dp,
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)
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flags["trackare_symptom_vs_crh_diagnosis"] = True
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alertes.append(
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f"Trackare symptôme ({t_code}) vs CRH ({c_code}) — vérification DIM requise"
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)
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return dp, flags, alertes
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# ── R1 — CRH CONFIRMED avec evidence forte → CRH prime ────────
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if crh_dp.verdict == "CONFIRMED" and _has_strong_evidence(crh_dp):
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dp = crh_dp.model_copy(deep=True)
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dp.reason = "R1 — CRH-only CONFIRMED avec preuves fortes"
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if t_code and t_code != c_code and t_fam != c_fam:
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flags["override_trackare_by_crh_confirmed"] = True
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alertes.append(
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f"DP final basé CRH-only CONFIRMED ({c_code}) — "
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f"Trackare ({t_code}) écarté (preuves CRH supérieures)"
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)
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else:
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flags["crh_confirmed_coherent"] = True
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# R5 post-hoc
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dp, r5_flags, r5_alertes = _apply_r5(dp, crh_dp, allow_symptom_dp)
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flags.update(r5_flags)
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alertes.extend(r5_alertes)
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return dp, flags, alertes
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# ── R2 — Trackare non-symptôme, cohérent CRH → confirmer ──────
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if (
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not t_code.startswith("R")
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and not t_code.startswith("Z")
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and (t_code == c_code or t_fam == c_fam or _code_in_candidates(t_code, crh_dp))
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):
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dp = _make_selection(
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code=trackare_dp.chosen_code,
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term=trackare_dp.chosen_term,
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verdict="CONFIRMED",
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confidence="high",
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evidence=[
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"Source: Trackare (codage établissement)",
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f"Trackare {t_code} corroboré par CRH (candidat {c_code})",
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],
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reason="R2 — Trackare non-symptôme corroboré par CRH",
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source_sel=crh_dp,
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)
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flags["trackare_confirmed_by_crh"] = True
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return dp, flags, alertes
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# ── R4 — Ambigu / preuves faibles → REVIEW ────────────────────
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if trackare_dp:
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base = trackare_dp
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base_label = "Trackare"
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else:
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base = crh_dp
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base_label = "CRH"
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dp = _make_selection(
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code=base.chosen_code,
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term=base.chosen_term,
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verdict="REVIEW",
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confidence="medium",
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evidence=base.evidence[:2] + ["Preuves insuffisantes pour confirmation automatique"],
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reason="R4 — Ambigu / preuves faibles",
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source_sel=crh_dp,
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)
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flags["review_ambiguous"] = True
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alertes.append(f"DP ambigu ({base_label} {base.chosen_code or '?'}) — REVIEW")
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return dp, flags, alertes
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# ── R5 — Interdits auto-confirm (post-hoc) ────────────────────────
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def _apply_r5(
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dp: DPSelection,
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crh_dp: DPSelection | None,
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allow_symptom_dp: bool,
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) -> tuple[DPSelection, dict, list[str]]:
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"""Applique R5 : Z-code et R-code jamais auto-CONFIRMED (sauf whitelist)."""
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flags: dict = {}
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alertes: list[str] = []
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code = (dp.chosen_code or "").upper()
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# Z-code non whitelisté → forcer REVIEW
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if code.startswith("Z") and _family3(code) not in _Z_CODE_DP_WHITELIST:
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if dp.verdict == "CONFIRMED":
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dp.verdict = "REVIEW"
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dp.confidence = "medium"
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dp.evidence.append("R5 — Z-code non whitelisté en DP → REVIEW")
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dp.reason = (dp.reason or "") + " | R5 Z-code"
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flags["z_code_dp_review"] = True
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alertes.append(f"Z-code {code} en DP → REVIEW (R5)")
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# R-code avec candidat non-R disponible → REVIEW si allow_symptom_dp=false
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if (
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code.startswith("R")
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and not allow_symptom_dp
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and crh_dp
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and any(
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not (c.code or "").upper().startswith("R")
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for c in crh_dp.candidates
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if c.code
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)
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):
|
||||
if dp.verdict == "CONFIRMED":
|
||||
dp.verdict = "REVIEW"
|
||||
dp.confidence = "medium"
|
||||
dp.evidence.append("R5 — Symptôme R-code en DP avec candidat non-R disponible → REVIEW")
|
||||
dp.reason = (dp.reason or "") + " | R5 R-code"
|
||||
flags["r_code_dp_with_non_r_candidate"] = True
|
||||
alertes.append(f"R-code {code} en DP avec alternative non-R → REVIEW (R5)")
|
||||
|
||||
return dp, flags, alertes
|
||||
|
||||
|
||||
# ── Fonction publique ──────────────────────────────────────────────
|
||||
|
||||
|
||||
def finalize_dp(dossier: DossierMedical) -> DossierMedical:
|
||||
"""Point d'entrée unique du finalizer.
|
||||
|
||||
Lit ``dp_selection`` et ``document_type``, produit :
|
||||
- ``dp_trackare`` (si Trackare)
|
||||
- ``dp_crh_only`` (si CRH)
|
||||
- ``dp_final`` (arbitrage)
|
||||
- ``quality_flags`` (merge sans écraser)
|
||||
- ``alertes_codage`` (append)
|
||||
"""
|
||||
# ── 1. Identifier les sources DP ───────────────────────────────
|
||||
trackare_dp: DPSelection | None = None
|
||||
crh_dp: DPSelection | None = None
|
||||
|
||||
if dossier.dp_selection:
|
||||
sel = dossier.dp_selection
|
||||
reason = (sel.reason or "").lower()
|
||||
is_trackare_source = (
|
||||
dossier.document_type == "trackare"
|
||||
or "trackare" in reason
|
||||
or any("Trackare" in e for e in sel.evidence)
|
||||
)
|
||||
if is_trackare_source:
|
||||
trackare_dp = sel
|
||||
else:
|
||||
crh_dp = sel
|
||||
|
||||
# ── 2. Stocker les sources pour traçabilité ────────────────────
|
||||
dossier.dp_trackare = trackare_dp
|
||||
dossier.dp_crh_only = crh_dp
|
||||
|
||||
# ── 3. Arbitrage ───────────────────────────────────────────────
|
||||
dp_final, flags, alertes = decide_dp_final(trackare_dp, crh_dp)
|
||||
|
||||
# ── 4. Écrire les résultats ────────────────────────────────────
|
||||
dossier.dp_final = dp_final
|
||||
|
||||
# Merge quality_flags (ne pas écraser les flags existants)
|
||||
for k, v in flags.items():
|
||||
dossier.quality_flags[k] = v
|
||||
|
||||
# Append alertes_codage
|
||||
for alerte in alertes:
|
||||
if alerte not in dossier.alertes_codage:
|
||||
dossier.alertes_codage.append(alerte)
|
||||
|
||||
return dossier
|
||||
Reference in New Issue
Block a user