687 lines
25 KiB
PHP
687 lines
25 KiB
PHP
<?php
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namespace App\Services;
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use App\Models\MisMedicalHistory;
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use App\Models\MisMigrationPatient;
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use App\Models\MisReanimation;
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use App\Models\MisSurgicalOperation;
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use App\Models\ObservationPatient;
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use Carbon\Carbon;
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use Illuminate\Support\Facades\DB;
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class PatientService
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{
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/**
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* Получить плановых или экстренных пациентов
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*/
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public function getPlanOrEmergencyPatients(
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?string $type,
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bool $isHeadOrAdmin,
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int $branchId,
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DateRange $dateRange,
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bool $countOnly = false,
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bool $onlyIds = false,
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bool $includeCurrent = false,
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bool $fillableAuto = false
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) {
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// Получаем поступивших сегодня
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$recipientQuery = $this->buildRecipientQuery($type, $isHeadOrAdmin, $branchId, $dateRange, $fillableAuto);
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if ($fillableAuto)
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$recipientIds = $recipientQuery->distinct()->pluck('rf_MedicalHistoryID')->toArray();
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else
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$recipientIds = $recipientQuery->pluck('rf_MedicalHistoryID')->toArray();
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// Если нужно добавить уже находящихся в отделении
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if ($includeCurrent) {
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if ($fillableAuto) {
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$currentIds = $this->getHistoricalCurrentMedicalHistoryIds($branchId, $dateRange);
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} else {
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$currentIds = MisMigrationPatient::currentlyInTreatment($branchId)
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->pluck('rf_MedicalHistoryID')
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->toArray();
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}
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$medicalHistoryIds = array_unique(array_merge($recipientIds, $currentIds));
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} else {
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$medicalHistoryIds = $recipientIds;
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}
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if (empty($medicalHistoryIds)) {
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if ($countOnly) return 0;
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if ($onlyIds) return collect();
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return collect();
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}
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// Получаем истории
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$query = MisMedicalHistory::whereIn('MedicalHistoryID', $medicalHistoryIds)
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->select([
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'MedicalHistoryID',
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'FAMILY',
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'Name',
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'OT',
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'BD',
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'DateRecipient',
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'DateExtract',
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'rf_EmerSignID',
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'rf_kl_VisitResultID',
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])
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->with([
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'surgicalOperations' => function ($q) {
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$q->select([
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'SurgicalOperationID',
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'rf_MedicalHistoryID',
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'rf_kl_ServiceMedicalID',
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'Date',
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])->with(['serviceMedical' => function ($serviceQuery) {
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$serviceQuery->select([
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'ServiceMedicalID',
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'ServiceMedicalCode',
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'ServiceMedicalName',
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]);
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}]);
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},
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'outcomeMigration' => function ($q) {
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$q->select([
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'MigrationPatientID',
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'rf_MedicalHistoryID',
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'DateOut',
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'rf_DiagnosID',
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])->with(['mainDiagnosis' => function ($diagnosisQuery) {
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$diagnosisQuery->select([
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'DiagnosID',
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'rf_MKBID',
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])->with(['mkb' => function ($mkbQuery) {
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$mkbQuery->select([
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'MKBID',
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'DS',
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'NAME',
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]);
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}]);
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}]);
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},
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'migrations' => function ($q) use ($branchId) {
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$q->where('rf_StationarBranchID', $branchId)
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->select([
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'MigrationPatientID',
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'rf_MedicalHistoryID',
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'rf_DiagnosID',
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'DateIngoing',
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'rf_StationarBranchID',
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])
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->orderByDesc('DateIngoing')
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->with(['mainDiagnosis' => function ($diagnosisQuery) {
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$diagnosisQuery->select([
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'DiagnosID',
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'rf_MKBID',
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'rf_MigrationPatientID',
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])->with(['mkb' => function ($mkbQuery) {
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$mkbQuery->select([
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'MKBID',
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'DS',
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'NAME',
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]);
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}]);
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}]);
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},
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])
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->orderBy('DateRecipient', 'DESC');
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// Фильтруем по типу (план/экстренные)
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if ($type === 'plan') {
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$query->plan();
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} elseif ($type === 'emergency') {
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$query->emergency();
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}
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if ($countOnly) {
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return $query->count();
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}
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if ($onlyIds) {
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return $query->pluck('MedicalHistoryID');
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}
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return $query->get()->map(function ($patient) use ($recipientIds) {
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// Добавляем флаг "поступил сегодня"
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$patient->is_recipient_today = in_array($patient->MedicalHistoryID, $recipientIds);
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return $patient;
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});
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}
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/**
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* Получить всех пациентов в отделении (поступившие сегодня + уже лечащиеся)
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*/
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public function getAllPatientsInDepartment(
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bool $isHeadOrAdmin,
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int $branchId,
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DateRange $dateRange,
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bool $countOnly = false,
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bool $onlyIds = false,
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bool $fillableAuto = false
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) {
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// Поступившие сегодня
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$recipientIds = $this->buildRecipientQuery(null, $isHeadOrAdmin, $branchId, $dateRange, $fillableAuto)
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->pluck('rf_MedicalHistoryID')
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->toArray();
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// Уже находящиеся на лечении
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if ($fillableAuto) {
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$currentIds = $this->getHistoricalCurrentMedicalHistoryIds($branchId, $dateRange);
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} else {
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$currentIds = MisMigrationPatient::currentlyInTreatment($branchId)
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->pluck('rf_MedicalHistoryID')
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->toArray();
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}
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// Объединяем и убираем дубли
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$allIds = array_unique(array_merge($recipientIds, $currentIds));
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if (empty($allIds)) {
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if ($countOnly) return 0;
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return collect();
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}
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if ($countOnly) {
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return count($allIds);
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}
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if ($onlyIds) {
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return collect($allIds);
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}
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return MisMedicalHistory::whereIn('MedicalHistoryID', $allIds)
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->select([
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'MedicalHistoryID',
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'FAMILY',
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'Name',
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'OT',
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'BD',
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'DateRecipient',
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'DateExtract',
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'rf_EmerSignID',
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'rf_kl_VisitResultID',
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])
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->with([
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'surgicalOperations' => function ($q) {
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$q->select([
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'SurgicalOperationID',
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'rf_MedicalHistoryID',
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'rf_kl_ServiceMedicalID',
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'Date',
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])->with(['serviceMedical' => function ($serviceQuery) {
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$serviceQuery->select([
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'ServiceMedicalID',
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'ServiceMedicalCode',
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'ServiceMedicalName',
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]);
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}]);
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},
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'outcomeMigration' => function ($q) {
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$q->select([
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'MigrationPatientID',
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'rf_MedicalHistoryID',
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'DateOut',
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'rf_DiagnosID',
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])->with(['mainDiagnosis' => function ($diagnosisQuery) {
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$diagnosisQuery->select([
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'DiagnosID',
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'rf_MKBID',
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])->with(['mkb' => function ($mkbQuery) {
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$mkbQuery->select([
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'MKBID',
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'DS',
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'NAME',
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]);
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}]);
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}]);
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},
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'migrations' => function ($q) use ($branchId) {
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$q->where('rf_StationarBranchID', $branchId)
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->select([
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'MigrationPatientID',
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'rf_MedicalHistoryID',
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'rf_DiagnosID',
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'DateIngoing',
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'rf_StationarBranchID',
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])
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->orderByDesc('DateIngoing')
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->with(['mainDiagnosis' => function ($diagnosisQuery) {
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$diagnosisQuery->select([
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'DiagnosID',
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'rf_MKBID',
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'rf_MigrationPatientID',
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])->with(['mkb' => function ($mkbQuery) {
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$mkbQuery->select([
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'MKBID',
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'DS',
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'NAME',
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]);
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}]);
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}]);
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},
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])
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->orderBy('DateRecipient', 'DESC')
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->get()
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->map(function ($patient) use ($recipientIds) {
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$patient->is_recipient_today = in_array($patient->MedicalHistoryID, $recipientIds);
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return $patient;
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});
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}
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/**
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* Получить пациентов под наблюдением
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*/
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public function getObservationPatients(int $departmentId, bool $onlyIds = false)
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{
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$query = MisMedicalHistory::whereHas('observationPatient', function ($q) use ($departmentId) {
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$q->where('rf_department_id', $departmentId);
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});
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if (!$onlyIds) {
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$query->with(['observationPatient' => function ($query) use ($departmentId) {
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$query->where('rf_department_id', $departmentId)
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->select(['rf_medicalhistory_id', 'observation_patient_id', 'comment']);
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}])
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->orderBy('DateRecipient', 'DESC');
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}
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if ($onlyIds) $patients = $query->pluck('MedicalHistoryID');
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else {
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// Загрузка отношений, необходимых для FormattedPatientResource
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$query->with([
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'outcomeMigration.mainDiagnosis.mkb', // mkb через диагноз
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]);
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$patients = $query->get();
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}
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return $patients->map(function ($patient) {
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$patient->comment = $patient->observationPatient
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->pluck('comment')
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->filter()
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->implode('; ');
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return $patient;
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});
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}
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/**
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* Получить выбывших пациентов
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*/
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public function getOutcomePatients(
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int $branchId,
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DateRange $dateRange,
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string $outcomeType = 'all',
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bool $onlyIds = false
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) {
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$query = MisMedicalHistory::query()
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->where('MedicalHistoryID', '<>', 0)
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->whereHas('migrations', function ($migrationQuery) use ($branchId, $outcomeType) {
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$migrationQuery->where('rf_StationarBranchID', $branchId);
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if ($outcomeType === 'deceased') {
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$migrationQuery->whereIn('rf_kl_VisitResultID', [5, 6, 15, 16]);
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} elseif ($outcomeType === 'transferred') {
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$migrationQuery->whereIn('rf_kl_VisitResultID', [4, 14]);
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} elseif ($outcomeType === 'discharged') {
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$migrationQuery->whereIn('rf_kl_VisitResultID', [1, 11, 2, 12, 7, 18, 48]);
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} elseif ($outcomeType === 'without-transferred') {
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$migrationQuery->whereNotIn('rf_kl_VisitResultID', [4, 14])
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->where('rf_kl_VisitResultID', '<>', 0);
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}
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});
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if ($dateRange->isOneDay) {
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$query->where('DateExtract', '>', $dateRange->startSql())
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->where('DateExtract', '<=', $dateRange->endSql());
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} else {
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$startAt = $dateRange->startSql();
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$endDate = $dateRange->end()->toDateString();
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$query->where('DateExtract', '>', $startAt)
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->whereDate('DateExtract', '<=', $endDate);
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}
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if ($onlyIds) {
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return $query->pluck('MedicalHistoryID');
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}
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return $query
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->select([
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'MedicalHistoryID',
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'FAMILY',
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'Name',
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'OT',
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'BD',
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'DateRecipient',
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'DateExtract',
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'rf_EmerSignID',
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'rf_kl_VisitResultID',
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])
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->with([
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'outcomeMigration' => function ($q) {
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$q->select([
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'MigrationPatientID',
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'rf_MedicalHistoryID',
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'DateOut',
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'rf_DiagnosID',
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])->with(['mainDiagnosis' => function ($diagnosisQuery) {
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$diagnosisQuery->select([
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'DiagnosID',
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'rf_MKBID',
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])->with(['mkb' => function ($mkbQuery) {
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$mkbQuery->select([
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'MKBID',
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'DS',
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'NAME',
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]);
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}]);
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}]);
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},
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])
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->orderBy('DateRecipient', 'DESC')
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->get()
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->map(fn ($patient) => $this->addOutcomeInfo($patient));
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}
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/**
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* Получить пациентов, находящихся в реанимации на конец периода
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*/
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public function getReanimationPatients(
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int $branchId,
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DateRange $dateRange,
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bool $onlyIds = false
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) {
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$medicalHistoryIds = MisReanimation::query()
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->join('stt_migrationpatient as mp', 'mp.MigrationPatientID', '=', 'stt_reanimation.rf_MigrationPatientID')
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->where('stt_reanimation.rf_StationarBranchID', $branchId)
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->where('mp.rf_StationarBranchID', $branchId)
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->where('mp.rf_MedicalHistoryID', '<>', 0)
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->where('stt_reanimation.DateIn', '<=', $dateRange->endSql())
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->where(function ($query) use ($dateRange) {
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$query->where('stt_reanimation.DateOut', '>=', $dateRange->endSql())
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->orWhereNull('stt_reanimation.DateOut')
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->orWhereDate('stt_reanimation.DateOut', '1900-01-01')
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->orWhereDate('stt_reanimation.DateOut', '2222-01-01');
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})
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->distinct()
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->pluck('mp.rf_MedicalHistoryID')
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->toArray();
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if (empty($medicalHistoryIds)) {
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return collect();
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}
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if ($onlyIds) {
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return collect($medicalHistoryIds);
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}
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return MisMedicalHistory::whereIn('MedicalHistoryID', $medicalHistoryIds)
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->select([
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'MedicalHistoryID',
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'FAMILY',
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'Name',
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'OT',
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'BD',
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'DateRecipient',
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'DateExtract',
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'rf_EmerSignID',
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'rf_kl_VisitResultID',
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])
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->with([
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'surgicalOperations' => function ($q) {
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$q->select([
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'SurgicalOperationID',
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'rf_MedicalHistoryID',
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'rf_kl_ServiceMedicalID',
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'Date',
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])->with(['serviceMedical' => function ($serviceQuery) {
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$serviceQuery->select([
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'ServiceMedicalID',
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'ServiceMedicalCode',
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'ServiceMedicalName',
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]);
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}]);
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},
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'outcomeMigration' => function ($q) {
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$q->select([
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'MigrationPatientID',
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'rf_MedicalHistoryID',
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'DateOut',
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'rf_DiagnosID',
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])->with(['mainDiagnosis' => function ($diagnosisQuery) {
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$diagnosisQuery->select([
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'DiagnosID',
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'rf_MKBID',
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])->with(['mkb' => function ($mkbQuery) {
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$mkbQuery->select([
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'MKBID',
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'DS',
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'NAME',
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]);
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}]);
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}]);
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},
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])
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->orderBy('DateRecipient', 'DESC')
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->get();
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}
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/**
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* Получить пациентов с операциями
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*/
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public function getSurgicalPatients(
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string $type,
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int $branchId,
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DateRange $dateRange,
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bool $countOnly = false
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) {
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$query = MisSurgicalOperation::where('rf_StationarBranchID', $branchId)
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->completed()
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->where('Date', '>=', $dateRange->startSql())
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->where('Date', '<=', $dateRange->endSql());
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// ->whereBetween('Date', [$dateRange->startSql(), $dateRange->endSql()]);
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if ($type === 'plan') {
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$query->where('rf_TypeSurgOperationInTimeID', 6);
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} else {
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$query->whereIn('rf_TypeSurgOperationInTimeID', [4, 5]);
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}
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if ($countOnly) {
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return $query->count();
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}
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return $query->get();
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}
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/**
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* Получить текущих пациентов
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*/
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public function getCurrentPatients(int $branchId, bool $countOnly = false)
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{
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$medicalHistoryIds = MisMigrationPatient::currentlyInTreatment($branchId)
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->pluck('rf_MedicalHistoryID')
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->unique()
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->toArray();
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if (empty($medicalHistoryIds)) {
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return $countOnly ? 0 : collect();
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}
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$query = MisMedicalHistory::whereIn('MedicalHistoryID', $medicalHistoryIds)
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->currentlyHospitalized()
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->with(['surgicalOperations'])
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->orderBy('DateRecipient', 'DESC');
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if ($countOnly) {
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return $query->count();
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}
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return $query->get();
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}
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/**
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* Собрать базовый запрос для пациентов
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*/
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private function buildPatientQuery(
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?string $type,
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bool $isHeadOrAdmin,
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int $branchId,
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DateRange $dateRange
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) {
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if ($isHeadOrAdmin) {
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$query = MisMigrationPatient::whereInDepartment($branchId)
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->where('DateIngoing', '>=', $dateRange->startSql())
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->where('DateIngoing', '<=', $dateRange->endSql());
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// ->whereBetween('DateIngoing', [$dateRange->startSql(), $dateRange->endSql()]);
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} else {
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$query = MisMigrationPatient::currentlyInTreatment($branchId)
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->where('DateIngoing', '>=', $dateRange->startSql())
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->where('DateIngoing', '<=', $dateRange->endSql());
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// ->whereBetween('DateIngoing', [$dateRange->startSql(), $dateRange->endSql()]);
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}
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$medicalHistoryIds = $query->pluck('rf_MedicalHistoryID')->toArray();
|
||
|
||
if (empty($medicalHistoryIds)) {
|
||
return MisMedicalHistory::whereRaw('1 = 0');
|
||
}
|
||
|
||
$query = MisMedicalHistory::whereIn('MedicalHistoryID', $medicalHistoryIds);
|
||
|
||
if ($type === 'plan') {
|
||
$query->plan();
|
||
} elseif ($type === 'emergency') {
|
||
$query->emergency();
|
||
}
|
||
|
||
if (!$isHeadOrAdmin && !in_array($type, ['discharged', 'transferred', 'deceased'])) {
|
||
$query->currentlyHospitalized();
|
||
}
|
||
|
||
return $query;
|
||
}
|
||
|
||
/**
|
||
* Построить запрос для поступивших пациентов
|
||
*/
|
||
private function buildRecipientQuery(
|
||
?string $type,
|
||
bool $isHeadOrAdmin,
|
||
int $branchId,
|
||
DateRange $dateRange,
|
||
bool $fillableAuto = false
|
||
) {
|
||
$startAt = $dateRange->start()->copy()->subDay()->format('Y-m-d H:i:s');
|
||
$endAt = $dateRange->end()->copy()->addDay()->format('Y-m-d H:i:s');
|
||
|
||
if ($dateRange->isOneDay) {
|
||
$startAt = $dateRange->startSql();
|
||
$endAt = $dateRange->endSql();
|
||
}
|
||
|
||
$query = DB::table('stt_medicalhistory as mh')
|
||
->selectRaw('mh."MedicalHistoryID" as "rf_MedicalHistoryID"')
|
||
->where('mh.MedicalHistoryID', '<>', 0);
|
||
|
||
$query->whereExists(function ($subQuery) use ($branchId, $startAt, $endAt) {
|
||
$subQuery->select(DB::raw(1))
|
||
->from('stt_migrationpatient as mp')
|
||
->whereColumn('mp.rf_MedicalHistoryID', 'mh.MedicalHistoryID')
|
||
->where('mp.rf_StationarBranchID', $branchId)
|
||
->where('mp.DateIngoing', '>', $startAt)
|
||
->where('mp.DateIngoing', '<=', $endAt);
|
||
});
|
||
|
||
if ($type === 'plan') {
|
||
$query->where('mh.rf_EmerSignID', 1);
|
||
} elseif ($type === 'emergency') {
|
||
$query->whereIn('mh.rf_EmerSignID', [2, 4]);
|
||
}
|
||
|
||
return $query->distinct();
|
||
}
|
||
|
||
private function getHistoricalCurrentMedicalHistoryIds(int $branchId, DateRange $dateRange): array
|
||
{
|
||
// Исторический срез по основной таблице миграций:
|
||
// для каждой истории болезни берём последнюю миграцию в отделении
|
||
// на момент конца периода и проверяем, что пациент числился в отделении.
|
||
$latestRows = DB::table('stt_migrationpatient')
|
||
->select('rf_MedicalHistoryID', DB::raw('MAX("MigrationPatientID") as max_migration_patient_id'))
|
||
->where('rf_StationarBranchID', $branchId)
|
||
->where('rf_MedicalHistoryID', '<>', 0)
|
||
->where('DateIngoing', '<=', $dateRange->endSql())
|
||
->groupBy('rf_MedicalHistoryID');
|
||
|
||
return DB::table('stt_migrationpatient as mp')
|
||
->joinSub($latestRows, 'latest', function ($join) {
|
||
$join->on('mp.rf_MedicalHistoryID', '=', 'latest.rf_MedicalHistoryID')
|
||
->on('mp.MigrationPatientID', '=', 'latest.max_migration_patient_id');
|
||
})
|
||
->join('stt_medicalhistory as mh', 'mh.MedicalHistoryID', '=', 'mp.rf_MedicalHistoryID')
|
||
->where('mp.rf_StationarBranchID', $branchId)
|
||
->where('mh.DateRecipient', '<=', $dateRange->endSql())
|
||
->where('mp.DateOut', '>=', $dateRange->endSql())
|
||
->where(function ($query) use ($dateRange) {
|
||
$query->where('mh.DateExtract', '>', $dateRange->endSql())
|
||
->orWhereDate('mh.DateExtract', '1900-01-01');
|
||
})
|
||
->distinct()
|
||
->pluck('mp.rf_MedicalHistoryID')
|
||
->toArray();
|
||
}
|
||
|
||
/**
|
||
* Добавить информацию об исходе пациенту
|
||
*/
|
||
private function addOutcomeInfo(MisMedicalHistory $patient)
|
||
{
|
||
$latestMigration = $patient->migrations
|
||
->whereNotNull('DateOut')
|
||
->where('DateOut', '<>', '1900-01-01')
|
||
->sortByDesc('DateOut')
|
||
->first();
|
||
|
||
if ($latestMigration) {
|
||
$patient->outcome_type = $this->getOutcomeTypeName($latestMigration->rf_kl_VisitResultID);
|
||
$patient->outcome_date = $latestMigration->DateOut;
|
||
$patient->visit_result_id = $latestMigration->rf_kl_VisitResultID;
|
||
}
|
||
|
||
return $patient;
|
||
}
|
||
|
||
/**
|
||
* Получить количество пациентов по типу с учетом уже находящихся в отделении
|
||
*/
|
||
public function getPatientsCountWithCurrent(
|
||
?string $type,
|
||
bool $isHeadOrAdmin,
|
||
int $branchId,
|
||
DateRange $dateRange
|
||
): int {
|
||
return $this->getPlanOrEmergencyPatients(
|
||
$type,
|
||
$isHeadOrAdmin,
|
||
$branchId,
|
||
$dateRange,
|
||
true,
|
||
false,
|
||
true
|
||
);
|
||
}
|
||
|
||
/**
|
||
* Получить название типа исхода
|
||
*/
|
||
private function getOutcomeTypeName(int $visitResultId): string
|
||
{
|
||
return match($visitResultId) {
|
||
1, 7, 8, 9, 10, 11, 48, 49, 124 => 'Выписка',
|
||
2, 3, 4, 12, 13, 14 => 'Перевод',
|
||
5, 6, 15, 16 => 'Умер',
|
||
default => 'Другое (' . $visitResultId . ')'
|
||
};
|
||
}
|
||
}
|