2. Discharge medication reconciliation¶

{
  "med_0": {
    "type": "choice",
    "instructions": "According to `discharge_medication_text`, what happens at discharge to the pre-admission medication `pre_admission_medications[0]` (Hydrochlorothiazide 25 MG Oral Tablet)?",
    "criteria": {
      "continued": "Continued at the same dose, either named explicitly or covered by a blanket statement such as 'continue all other medications'",
      "dose_changed": "Still taken, but the dose, frequency or directions change, for example increased, reduced, or changed to as-needed",
      "withheld": "Paused temporarily, with a plan to restart later",
      "stopped": "Stopped, discontinued, completed, or replaced by a different drug",
      "not_mentioned": "Not named and not covered by any blanket statement, so its status at discharge is unknown"
    }
  },
  "allergy_conflict": {
    "type": "noul",
    "instructions": "Does `discharge_medication_text` prescribe a medication that belongs to the same drug class as one of the patient's drug allergies listed in `patient.allergies`? Brand names and combination products count.",
    "criteria": {
      "true": "A prescribed or continued medication contains a drug from an allergy's drug class.",
      "false": "No prescribed medication belongs to an allergy's drug class. Food, environmental and animal allergies do not count."
    }
  },
  "duplicate_therapy": {
    "type": "noul",
    "instructions": "After discharge, will the patient be taking two or more medications with the same active ingredient or from the same therapeutic class for the same purpose, based on `pre_admission_medications` and `discharge_medication_text`?",
    "criteria": {
      "true": "Two or more concurrent medications share an active ingredient (including inside brand-name or combination products) or a therapeutic class.",
      "false": "Each active ingredient and therapeutic class appears once. Duplicates that the discharge text stops do not count."
    }
  },
  "interaction": {
    "type": "noul",
    "instructions": "Does a medication newly started in `discharge_medication_text` have a well-known, clinically important interaction with another medication the patient will be taking after discharge?",
    "criteria": {
      "true": "A new medication has a recognised interaction that prescribing guidance says to avoid or to manage actively.",
      "false": "New medications have no clinically important interaction with the rest of the regimen, or no medication is newly started."
    }
  },
  "justification": {
    "type": "score",
    "instructions": "How well does `discharge_medication_text` explain the medication changes it makes?",
    "criteria": [
      "Changes are made with no reasons given, or a blanket 'continue all' is used when the regimen clearly needed review",
      "New or changed medications are listed, but most have no reason or follow-up plan",
      "Most changes have a reason, but some reasons, durations or follow-up plans are missing",
      "Every change has a clear reason, with durations or follow-up plans where needed"
    ]
  }
}