Managing Patient Cycles

Overview

In DataMed, a cycle (Ingreso) represents a patient’s enrollment period in the sleep apnea program. Each cycle tracks the patient’s progress through an 18-month treatment period, with automatic month calculation (mes_capita).

DataMed uses the term “Ingreso” (cycle/enrollment) to track distinct treatment periods. All clinical data is linked to a specific cycle, allowing historical tracking when patients re-enroll.

Cycle Lifecycle

A cycle progresses through three possible states:

ACTIVO (Active)

Active State

Patient is currently enrolled in the program
Clinical data can be recorded
Monthly billing (capitación) is calculated
Only ONE active cycle allowed per patient
Created automatically when registering a new patient

SUSPENDIDO (Suspended)

Suspended State

Temporary program pause
Clinical data recording disabled
Can be reactivated to ACTIVO
Can be finalized to TERMINADO

TERMINADO (Finished)

Finished State

Cycle is permanently closed
Requires end date and reason
Cannot be reopened
Historical data preserved
Allows creation of new cycle

Cycle Month Calculation

DataMed automatically calculates which month (1-18) a patient is in:

# From apps/patients/models.py:166
@property
def mes_capita(self):
    """Calcula el mes actual del programa (1 al 18)"""
    if not self.fecha_inicio:
        return 0
    
    hoy = date.today()
    # Calculate months elapsed
    meses = (hoy.year - self.fecha_inicio.year) * 12 + \
            (hoy.month - self.fecha_inicio.month) + 1
    
    if meses < 1: return 1
    if meses > 18: return 18
    return meses

The mes_capita is a computed property, not a database field. It’s calculated in real-time based on the fecha_inicio date.

Accessing Cycle Management

Navigate to Follow-ups Manager

Go to /patients/follow to access the cycle management interface

Search for Patient

Use the search bar to find patients by name, apellido, or document number

View Patient Cycles

All cycles (ingresos) for each patient are displayed with their current status

Changing Cycle Status

Terminating a Cycle (ACTIVO → TERMINADO)

When finalizing a cycle, you must provide additional information:

Select Terminate Action

Click the terminate button for the cycle you want to close

Fill Required Fields

A form will appear requiring:

# Required fields for termination
fecha_terminacion = forms.DateField()  # End date
motivo_estado = forms.TextField()  # Reason for termination

Submit

The cycle status changes to TERMINADO and is archived

Implementation details (see apps/patients/views.py:change_status_entry, line 169):

def change_status_entry(request, entry_id, new_status):
    ingreso = get_object_or_404(Ingreso, id=entry_id)
    
    if request.method == 'POST' and new_status == 'TERMINADO':
        # Capture required closure data
        ingreso.fecha_fin = request.POST.get('fecha_terminacion')
        ingreso.motivo = request.POST.get('motivo_estado')
        ingreso.estado = 'TERMINADO'
        ingreso.save()
        
        messages.success(request, 
            f"Ciclo de {ingreso.paciente.nombre} finalizado y archivado ✅")
    
    return redirect('patients_follow')

Suspending a Cycle (ACTIVO → SUSPENDIDO)

Suspended cycles do not require an end date or reason, but they prevent new clinical data entry.

URL Pattern: /patients/ingreso/estado/<entry_id>/SUSPENDIDO/

Reactivating a Cycle (SUSPENDIDO → ACTIVO)

You can reactivate a suspended cycle as long as no other cycle is currently ACTIVO for that patient.

URL Pattern: /patients/ingreso/estado/<entry_id>/ACTIVO/

Creating a New Cycle

Patients can have multiple cycles over time, but only one can be ACTIVO at a time.

When to Create a New Cycle

Patient completes 18-month program and re-enrolls
Patient returns after termination for a new treatment period
Program change requires new cycle tracking

Creation Process

Verify No Active Cycles

The system checks for existing ACTIVO or SUSPENDIDO cycles:

tiene_ciclo_abierto = patient.ingresos.filter(
    estado__in=['ACTIVO', 'SUSPENDIDO']
).exists()

Access New Cycle Form

Navigate to /patients/ingreso/nuevo/<patient_id>/

Set Start Date

Provide the new cycle start date in the modal form

Submit

A new ACTIVO cycle is created:

Ingreso.objects.create(
    paciente=patient,
    fecha_inicio=fecha,
    estado='ACTIVO'
)

Implementation (see apps/patients/views.py:create_new_entry, line 193):

def create_new_entry(request, patient_id):
    patient = get_object_or_404(Patient, id=patient_id)
    
    if request.method == 'POST':
        fecha = request.POST.get('fecha_inicio')
        
        # SECURITY: Check for open cycles before creating
        tiene_ciclo_abierto = patient.ingresos.filter(
            estado__in=['ACTIVO', 'SUSPENDIDO']
        ).exists()
        
        if tiene_ciclo_abierto:
            messages.error(request, 
                "No se puede iniciar nuevo ciclo: El paciente tiene un proceso pendiente.")
        else:
            # CREATE NEW CYCLE
            Ingreso.objects.create(
                paciente=patient,
                fecha_inicio=fecha,
                estado='ACTIVO'
            )
            messages.success(request, 
                f"¡Nuevo ciclo iniciado para {patient.nombre}!")
            
    return redirect('patients_follow')

Critical Validation: You cannot create a new cycle while the patient has an ACTIVO or SUSPENDIDO cycle. The previous cycle must be TERMINADO first.

Data Isolation Between Cycles

When a new cycle is created, clinical data is properly isolated:

How It Works

Old Cycle: All exams remain linked to the TERMINADO cycle
New Cycle: Clinical history view shows only ACTIVO cycle data
Historical Access: Previous cycle data is preserved but not displayed in current workflows

# From apps/exams/views.py:patient_clinical (line 23)
ingreso_actual = patient.ingresos.filter(estado='ACTIVO').first()

if ingreso_actual:
    # Only show exams from the ACTIVE cycle
    monitoreos = Monitoreo.objects.filter(ingreso=ingreso_actual)
    sesiones_psicologia = Psicologia.objects.filter(ingreso=ingreso_actual)
    # ... etc
else:
    # No active cycle = empty lists
    monitoreos = sesiones_psicologia = []

This design prevents confusion when a patient starts “Month 1” again in a new cycle—previous exam data won’t interfere with the new treatment period.

Filtering Patients by Cycle Month

In the patient list view, you can filter by mes_capita:

# From apps/patients/views.py:38
mes_filtro = request.GET.get('mes_filtro', '')

if mes_filtro:
    filtered_patients = []
    for p in patients:
        ingreso = p.ingreso_activo 
        if ingreso and str(ingreso.mes_capita) == str(mes_filtro):
            filtered_patients.append(p)
    patients = filtered_patients

Because mes_capita is a property (not a database field), filtering requires iteration rather than database queries.

Patient Properties for Cycle Status

The Patient model provides convenient properties:

# From apps/patients/models.py:128
@property
def ingreso_activo(self):
    # Get the ACTIVE cycle
    return self.ingresos.filter(estado='ACTIVO').first()

@property
def esta_activo(self):
    # Check if patient has any active cycle
    return self.ingresos.filter(estado='ACTIVO').exists()

Common Scenarios

Patient Completes 18-Month Program

Scenario: Patient reaches month 18 and completes treatment successfullySteps:

Change cycle status to TERMINADO
Enter completion date and reason (e.g., “Programa completado exitosamente”)
Cycle is archived with all clinical data preserved
If patient re-enrolls later, create a new cycle

Patient Temporarily Leaves Program

Scenario: Patient needs to pause treatment temporarilySteps:

Change cycle status to SUSPENDIDO
When patient returns, reactivate to ACTIVO
Month calculation continues from original start date
If patient won’t return, finalize to TERMINADO

Patient Drops Out

Scenario: Patient discontinues treatment before completionSteps:

Change cycle status to TERMINADO
Enter discontinuation date
Enter reason (e.g., “Abandono del programa”, “Traslado a otra ciudad”)
Cycle is permanently closed

Program Change Required

Scenario: Patient needs to switch from AOS program to another programSteps:

Terminate current cycle with appropriate reason
Update patient record (programa field)
Create new cycle with new start date
New cycle begins at Month 1

Billing Implications

The mes_capita property is used for billing calculations:

# Patient model (line 126)
valor_capita = models.DecimalField(
    max_digits=10,
    decimal_places=2,
    default=259783
)

Only patients with ACTIVO status should be included in monthly billing reports. Filter by estado='ACTIVO' when generating capitación lists.

URL Reference

Cycle Management: /patients/follow
Change Status: /patients/ingreso/estado/<entry_id>/<new_status>/
Create New Cycle: /patients/ingreso/nuevo/<patient_id>/

Technical Schema

class Ingreso(models.Model):
    ESTADO_CHOICES = [
        ('ACTIVO', 'Activo'),
        ('SUSPENDIDO', 'Suspendido'),
        ('TERMINADO', 'Terminado')
    ]

    paciente = models.ForeignKey(
        'Patient', 
        on_delete=models.CASCADE, 
        related_name='ingresos'
    )
    fecha_inicio = models.DateField()
    fecha_fin = models.DateField(null=True, blank=True)
    estado = models.CharField(
        max_length=20, 
        choices=ESTADO_CHOICES, 
        default='ACTIVO'
    )
    motivo = models.TextField(blank=True, null=True)

Best Practices

Document Everything

Always provide clear, detailed reasons when terminating cycles

Regular Reviews

Periodically review suspended cycles to finalize or reactivate

Accurate Dates

Use actual dates for cycle transitions, not future dates

One Active Rule

Ensure only ONE active cycle per patient at all times

Next Steps

Record Exams

Learn how to record clinical data for active cycles

Export Data

Generate reports including cycle information

Documentation Index

​Overview

​Cycle Lifecycle

​Cycle Month Calculation

​Accessing Cycle Management

​Changing Cycle Status

​Terminating a Cycle (ACTIVO → TERMINADO)

​Suspending a Cycle (ACTIVO → SUSPENDIDO)

​Reactivating a Cycle (SUSPENDIDO → ACTIVO)

​Creating a New Cycle

​When to Create a New Cycle

​Creation Process

​Data Isolation Between Cycles

​How It Works

​Filtering Patients by Cycle Month

​Patient Properties for Cycle Status

​Common Scenarios

​Billing Implications

​URL Reference

​Technical Schema

​Best Practices

Document Everything

Regular Reviews

Accurate Dates

One Active Rule

​Next Steps

Record Exams

Export Data

Overview

Cycle Lifecycle

Cycle Month Calculation

Accessing Cycle Management

Changing Cycle Status

Terminating a Cycle (ACTIVO → TERMINADO)

Suspending a Cycle (ACTIVO → SUSPENDIDO)

Reactivating a Cycle (SUSPENDIDO → ACTIVO)

Creating a New Cycle

When to Create a New Cycle

Creation Process

Data Isolation Between Cycles

How It Works

Filtering Patients by Cycle Month

Patient Properties for Cycle Status

Common Scenarios

Billing Implications

URL Reference

Technical Schema

Best Practices

Next Steps