Compare question sets

q-v0.1 → q-v0.2

Why it changed

q-v0.2 rewords two criteria, documentation_complete's yes criterion and missing_evidence's TREATMENT_HISTORY option, so that a record stating the patient never took methotrexate counts as documented treatment history. It was adopted on gen-v0.2-dev by a rule fixed in advance (330/400 correct against q-v0.1's 257/400, 0 unsafe for both); RESULTS.md notes that part of the gain is alignment with the generator's own labelling convention for never-taken methotrexate.

docs/RESULTS.md

12 → 12 questions0 added · 2 changed · 0 removed · 10 unchangedkey: added words ~~removed words~~

02documentation_complete
yes/no · Noul
CHANGED
Does this request include every item the policy lists under submission documentation?
yes (true)
The insurance member ID, a clinician note supporting the diagnosis, and the patient's treatment history (including whether and when methotrexate was taken) are all present (a statement that the patient never took methotrexate counts as treatment history).
no (false)
At least one required item is missing, unavailable, or marked as not provided.
04missing_evidence
choice · Choice
CHANGED
What is the most important information missing from this request for the policy decision, if any?
Options: DIAGNOSIS, TREATMENT_HISTORY, LAB_RESULT, DOSAGE, INSURANCE_INFORMATION, NONE
DIAGNOSIS
No established diagnosis of rheumatoid arthritis is documented.
TREATMENT_HISTORY
The ~~patient's methotrexate treatment history (dates~~records do not say whether or ~~outcome) is not~~ when the patient took methotrexate. A record stating that the patient never took methotrexate counts as documented treatment history.
LAB_RESULT
A lab result that the decision depends on is missing.
DOSAGE
The requested dose or regimen is missing.
INSURANCE_INFORMATION
The insurance member ID or plan information is missing.
NONE
Nothing that the policy requires is missing.

10 unchanged questions: diagnosis_support, material_contradiction, mtx_start_month, mtx_start_day, mtx_start_year, mtx_end_status, mtx_end_month, mtx_end_day, mtx_end_year, mtx_inadequate_response

01diagnosis_support
yes/no · Noul
UNCHANGED
Do the clinical documents establish a clinician-documented diagnosis of rheumatoid arthritis for this patient, as the policy requires?
yes (true)
A clinician states that the patient has rheumatoid arthritis as an established diagnosis.
no (false)
The diagnosis is absent, only suspected, pending workup, or describes someone other than the patient.
03material_contradiction
yes/no · Noul
UNCHANGED
Do the case documents contain a material contradiction about the patient's diagnosis or treatment history that affects this authorization?
yes (true)
Two sources make incompatible claims about the same fact, for example one record shows a medication was taken while another says it was never tried.
no (false)
The sources agree, or differ only in wording, detail, or precision without conflicting.
05mtx_start_month
choice · Choice
UNCHANGED
In which month did the patient (not a relative or other person) start taking methotrexate? Answer 'none' if the documents do not state the month.
Options: January … December, none
none
The documents do not state this, or the patient never took the medication.
06mtx_start_day
choice · Choice
UNCHANGED
On which day of the month (1-31) did the patient (not a relative or other person) start taking methotrexate? Answer 'none' if the day is not stated, for example when only a month is given.
Options: 1 … 31, none
none
The documents do not state this, or the patient never took the medication.
07mtx_start_year
choice · Choice
UNCHANGED
In which year did the patient (not a relative or other person) start taking methotrexate? Answer 'none' if no year is stated for this event.
Options: years found in the case, none
none
The documents do not state this, or the patient never took the medication.
08mtx_end_status
choice · Choice
UNCHANGED
What is the status of the patient's own methotrexate treatment (not a relative's)?
Options: ended, ongoing, not_stated
ended
The documents say the patient stopped taking methotrexate.
ongoing
The documents say the patient is still taking methotrexate.
not_stated
The documents do not say, or the patient never took methotrexate.
09mtx_end_month
choice · Choice
UNCHANGED
In which month did the patient (not a relative or other person) stop taking methotrexate? Answer 'none' if the documents do not state the month.
Options: January … December, none
none
The documents do not state this, or the patient never took the medication.
10mtx_end_day
choice · Choice
UNCHANGED
On which day of the month (1-31) did the patient (not a relative or other person) stop taking methotrexate? Answer 'none' if the day is not stated, for example when only a month is given.
Options: 1 … 31, none
none
The documents do not state this, or the patient never took the medication.
11mtx_end_year
choice · Choice
UNCHANGED
In which year did the patient (not a relative or other person) stop taking methotrexate? Answer 'none' if no year is stated for this event.
Options: years found in the case, none
none
The documents do not state this, or the patient never took the medication.
12mtx_inadequate_response
yes/no · Noul
UNCHANGED
Is it documented that the patient's own methotrexate treatment was ineffective (inadequate response) or was stopped because of intolerance or a contraindication?
yes (true)
A clinician documents that methotrexate did not adequately control this patient's disease, or that it caused intolerance or is contraindicated for this patient.
no (false)
There is no such documentation for this patient; statements about relatives or other people do not count, and neither does a different medication.