- Shipped
- August 26, 2026 at 5:30 AM UTC
- Author
- Kamo
- Commit
- b414faa
MeasurePatientResult is the point of this commit. A practice shown "67% controlled" can do nothing with it; a practice shown the 41 NAMED patients in the denominator and not the numerator has a work list, and closing that list is the only thing that moves the number. Every quality product that gets used is built around that table; every one that gets ignored stops at the percentage. Exclusion and exception are modelled separately because reporting programmes audit one and not the other. An exclusion says the measure never applied — a bilateral mastectomy, so mammogram screening is not care that was missed. An exception says it applied and could not be delivered — the patient decoderd. Recording one as the other is how a practice fails a review. The arithmetic is not the obvious fraction. Exclusions and exceptions both LEAVE the denominator, so numerator/denominator overstates a practice's failure by however many patients it legitimately could not treat — on 100 eligible with 10 excluded and 5 excepted, twelve points of score. effectiveDenominator() is named rather than left implicit for exactly that reason. An empty denominator reports NO rate, never zero. "No eligible patients" and "no eligible patient received the care" are opposite facts, and a dashboard showing 0% for the first tells a practice it is failing at something it was never asked to do. Reports are append-only. A rate submitted to a payer must never move; re-running a period writes a new report, and two reports for one period are the record that the number changed and when — which is what an audit asks about. higherIsBetter lives on the report because the direction is not uniform: CMS122 counts patients whose diabetes is POORLY controlled, CMS165 counts patients whose blood pressure IS controlled. A dashboard colouring every rate the same way tells half of them the opposite of the truth.