feat(ai-script): 单一聚焦的上下文也项目相关 — 日期/主诉用"那次诊断"非泛泛最近

聚焦一个漏诊项时,喂 LLM 的上下文应针对该项目,而非泛泛"最近一次就诊":
- orchestrator resolveReasonTrigger 扩展:除触发医生/日期,再取该诊断**那次接诊的主诉**
  (evidence.factIds[0]→诊断 fact→source_encounter→该 encounter 的 emr.illness_desc)
- reason 加 triggerChiefComplaint;prompt 注入:
  · 智能日期 = top.triggerDate(该漏诊项诊断日期)优先,非最近就诊
  · "那次就诊主诉" = top.triggerChiefComplaint(那次为什么来),非最近一次主诉
  · 医生 = top.triggerDoctor 优先
- 临床上下文"最近一次接触"降级为仅参考;fallback 同步用项目相关日期/医生

避免"缺牙2025-12诊断却说自从2026-03洁牙后"的错位。typecheck 0 + build + 25 测试通过。

Co-Authored-By: Claude Opus 4.8 (1M context) <noreply@anthropic.com>

apps/pac-service/src/modules/ai/calls/draft-plan-script/call.ts

@@ -90,16 +90,16 @@ function fallback(input: DraftPlanScriptInput): DraftPlanScriptOutput {
   const { patient, clinicName, plan, clinicalContext } = input;
   const branch = resolveAgeBranch(patient.age);
   const salutation = resolveSalutation({ nameMasked: patient.nameMasked, gender: patient.gender, branch });
-  const doctor = clinicalContext.primaryDoctorName ?? '您的主诊医生';
-  const dateDisplay =
-    smartDateDisplay(
-      clinicalContext.daysSinceLastVisit != null
-        ? new Date(Date.now() - clinicalContext.daysSinceLastVisit * 86400_000)
-        : null,
-      new Date(),
-    ) ?? '上次';
   // 漏诊项 = PAC 应治未治 reason(取 priorityScore 最高的一条)→ 转换层归一
   const topReason = [...(plan.reasons ?? [])].sort((a, b) => b.priorityScore - a.priorityScore)[0];
+  const doctor = topReason?.triggerDoctor ?? clinicalContext.primaryDoctorName ?? '您的主诊医生';
+  // 日期优先取"那次诊断"的(项目相关),否则退回最近一次就诊
+  const dateBasis = topReason?.triggerDate
+    ? new Date(topReason.triggerDate)
+    : clinicalContext.daysSinceLastVisit != null
+      ? new Date(Date.now() - clinicalContext.daysSinceLastVisit * 86400_000)
+      : null;
+  const dateDisplay = smartDateDisplay(dateBasis, new Date()) ?? '上次';
   const missed = topReason
     ? missedFromReason(topReason)
     : { label: plan.primaryScenarioLabel, key: null };

apps/pac-service/src/modules/ai/calls/draft-plan-script/input.types.ts

@@ -45,6 +45,9 @@ export interface DraftPlanScriptInput {
       triggerDoctor: string | null;
       /** 触发诊断/建议的日期(YYYY-MM-DD),给 LLM 在话术里用,如"上次姜医生 X 月 X 日给您检查时...") */
       triggerDate: string | null;
+      /** ⭐ 项目相关:该诊断**那次接诊**的主诉(emr illness_desc 原文)。
+       *  单一聚焦时优于"最近一次主诉"—— 缺牙是哪次来发现的、那次为什么来,更贴合本漏诊项。可空 */
+      triggerChiefComplaint?: string | null;
     }>;
   };
 

apps/pac-service/src/modules/ai/calls/draft-plan-script/prompt.ts

@@ -212,12 +212,15 @@ export function buildDraftPlanScriptPrompt(input: DraftPlanScriptInput): string
     clinicalContext.daysSinceLastVisit != null
       ? new Date(now.getTime() - clinicalContext.daysSinceLastVisit * 86400_000)
       : null;
-  const dateDisplay = smartDateDisplay(lastVisitDate, now) ?? '上次';
-  const topReason = [...plan.reasons].sort((a, b) => b.priorityScore - a.priorityScore)[0];
-  const missed = topReason ? missedFromReason(topReason) : { label: plan.primaryScenarioLabel, key: null };
+  // ⭐ 项目相关:日期/主诉/医生优先取"该漏诊项**那次诊断**"的,而非泛泛"最近一次就诊"
+  //   (top = priorityScore 最高那条 reason,见上方单一聚焦块)
+  const projectDate = top?.triggerDate ? new Date(top.triggerDate) : lastVisitDate;
+  const dateDisplay = smartDateDisplay(projectDate, now) ?? '上次';
+  const chiefComplaint = top?.triggerChiefComplaint ?? clinicalContext.lastChiefComplaint ?? null;
+  const missed = top ? missedFromReason(top) : { label: plan.primaryScenarioLabel, key: null };
   const kp = lookupKeyPoints(missed.key);
   const reviewDuration = lookupReviewDuration(missed.key);
-  const doctor = topReason?.triggerDoctor ?? clinicalContext.primaryDoctorName ?? '您的主诊医生';
+  const doctor = top?.triggerDoctor ?? clinicalContext.primaryDoctorName ?? '您的主诊医生';
   const ageGroup = resolveAgeGroup(patient.age);
   const ageFit = kp?.ageFit && ageGroup ? kp.ageFit[ageGroup] : null;
   const mrn = patient.medicalRecordNumber ?? null;
@@ -226,7 +229,8 @@ export function buildDraftPlanScriptPrompt(input: DraftPlanScriptInput): string
 
 ## ⭐ 程序已算好的事实(直接用,**不要自己改 / 不要自己推断或重新格式化**)
 - 智能称呼(开场用这个):${salutation}
-- 智能日期(开场"自从X检查后"用这个):${dateDisplay}
+- 智能日期(开场"自从X检查后"用这个 — 是**该漏诊项那次诊断**的日期,非泛泛最近):${dateDisplay}
+- 那次就诊主诉(该漏诊项那次来为什么看,可作开场关怀上下文,别照念医学词):${chiefComplaint ?? '无记录'}
 - 主漏诊项(本次**只讲这一个**,严禁提其他):${missed.label}
 - 接诊/主诊医生(以此人名义体现关怀):${doctor}
 - 复查时长(复查建议·检查说明 直接用原文):${reviewDuration}
@@ -259,8 +263,7 @@ ${personaLines}
 
 ## 临床上下文
 - 距上次到店:${clinicalContext.daysSinceLastVisit ?? '未知'} 天
-- 上次到店:${clinicalContext.lastVisitSummary ?? '无记录'}
-- 上次就诊主诉(患者原话,可作开场寒暄/关怀的上下文,别照念医学词):${clinicalContext.lastChiefComplaint ?? '无记录'}
+- 上次到店:${clinicalContext.lastVisitSummary ?? '无记录'}（最近一次接触,仅参考;本次聚焦的是上面"那次诊断"那次)
 - 该患者长期主诊医生:${clinicalContext.primaryDoctorName ?? '(未知)'}
 - 历史已做治疗:${clinicalContext.completedTreatmentCount} 项
 - 正在进行的治疗链(已在管,**不要再次邀约**这些类目;可作为"诊所记得 ta"的引用素材):

apps/pac-service/src/modules/ai/orchestrators/plan-script.orchestrator.ts

@@ -355,18 +355,32 @@ export class PlanScriptOrchestrator {
     // evidence.factIds[0] = 主触发 fact;关联 patient_facts.content.doctor_name + occurredAt
     // LLM 在 followup 段必须引用触发医生(姜医生发现智齿)而非全患者高频医生(李医生)
     const factById = new Map(facts.map((f) => [f.id, f]));
+    // encounter_external_id → 该次 EMR(取主诉 illness_desc 用)
+    const emrByEncounter = new Map<string, FactRow>();
+    for (const f of facts) {
+      if (f.type !== 'emr_record') continue;
+      const enc = (f.content as Record<string, unknown> | null)?.encounter_external_id as string | undefined;
+      if (enc && !emrByEncounter.has(enc)) emrByEncounter.set(enc, f);
+    }
+    // ⭐ 单一聚焦:trigger 信息要"项目相关"——这个漏诊项**那次诊断**的医生/日期/主诉,
+    //   不是泛泛的最近一次就诊(否则"缺牙2025-12诊断"却说"自从2026-03洁牙后"就错位)
     const resolveReasonTrigger = (r: PlanWithReasons['reasons'][number]) => {
       const evidence = (r.evidence ?? {}) as { factIds?: string[] };
       const leadFactId = evidence.factIds?.[0];
-      if (!leadFactId) return { doctor: null, date: null };
+      if (!leadFactId) return { doctor: null, date: null, chiefComplaint: null };
       const lead = factById.get(leadFactId);
-      if (!lead) return { doctor: null, date: null };
+      if (!lead) return { doctor: null, date: null, chiefComplaint: null };
       const c = lead.content as Record<string, unknown> | null;
       const doctor = (c?.doctor_name as string | undefined)?.trim() || null;
-      const date = lead.occurredAt
-        ? lead.occurredAt.toISOString().slice(0, 10)
-        : null;
-      return { doctor, date };
+      const date = lead.occurredAt ? lead.occurredAt.toISOString().slice(0, 10) : null;
+      // 该诊断所在接诊的主诉(项目相关)
+      const encId =
+        ((c?.source_encounter_external_id ?? c?.encounter_external_id) as string | undefined) || null;
+      const emr = encId ? emrByEncounter.get(encId) : undefined;
+      const chiefComplaint =
+        ((emr?.content as Record<string, unknown> | undefined)?.illness_desc as string | undefined)?.trim() ||
+        null;
+      return { doctor, date, chiefComplaint };
     };
 
     return {
@@ -401,6 +415,7 @@ export class PlanScriptOrchestrator {
             priorityScore: r.priorityScore,
             triggerDoctor: trig.doctor,
             triggerDate: trig.date,
+            triggerChiefComplaint: trig.chiefComplaint,
           };
         }),
       },