5cf7f272fa647c0014ef9671v1.5.2-Apr
cutoff: 2026-04-07
RD-MTPR (human)
MTPR (Monthly Treatment Plan Review) Data from 03/07/2026-04/07/2026
[Non-concerns] None Identified.
[Concerns] Patient's BMI remains significantly above the target of <30, currently at 55.9. Blood pressure management goal of <130/80 mmHg is not being met, with a 30-day average of 139/91 mmHg. Patient has been inactive for several months, impacting lifestyle goals.
[How I will follow up with the patient] I will send a summary and check in with the patient via chat.
The Weight Reduction goal to achieve and maintain a healthful weight at a BMI below 30 over the next 6 months remains unchanged and is not being met. BMI at 55.9 with last weigh in 4/6/26 in-clinic at 378.6 lbs. Pt has lost 12.4 lbs since his visit on 1/17/24 with a weight of 390.2 lbs. The Blood Pressure Management goal to reduce and maintain blood pressure to <130/80 mmHg over the next 6 months without symptoms associated with hypotension remains unchanged and is not being met. 30-day average BP is 139/91 mmHg (18 measurements, 6 days) with 0% vitals in normal range, a slightly worsening trend from November’s average of 130/87 mmHg (30 measurements) with 7% vitals in normal range. Pt measures at various times of the day with the highest range in the mornings of 130-149/88-97 mmHg. 39% (7 measurements) are in Stage 1 and 61% (11 measurements) are in Stage 2 for the month. Pt was inactive from 11/26/25-3/26/26 and no visits have been done with a health coach or RD, so no insights into lifestyle have been made. Sent summary and checked in with pt via chat.
Rubric — RD-MTPR
8/27(30%)
Judge:
claude-opus-4-71. Vitals Trend Reviewed
2/3
Specific numbers, trend direction, and breakdown of stages noted, but no possible reason or next step beyond stating averages.
→ “30-day average BP is 139/91 mmHg... a slightly worsening trend from November's average of 130/87 mmHg”
↑ Add hypothesis for worsening (e.g., inactivity period) tied explicitly to BP rise, plus a concrete next step.
2. Overall Health Concerns Identified
2/3
Major concerns (BMI, BP, inactivity) identified accurately but no plan for intervention given lack of recent visits.
→ “BMI remains significantly above the target... BP management goal... not being met... Patient has been inactive for several months”
↑ Note plan to re-engage patient with RD/health coach or document readiness/intervention pathway for each concern.
3. Overall Health Concerns Addressed
1/3
Concerns identified but addressing limited to a chat check-in; no intervention plan, readiness assessment, or future plan documented.
→ “I will send a summary and check in with the patient via chat.”
↑ Outline specific interventions or referrals (RD/health coach), assess readiness, and schedule a follow-up plan for each concern.
4. Medication Review
0/3
No medication review present at all in the MTPR.
↑ Review meds: new/changed, flag empty/irregular, action discontinuations, flag dx without meds when vitals abnormal.
5. Labs
0/3
No mention of labs, A1C, lipid panel, or any lab follow-up plan.
↑ Review historical lab trends, address due labs with patient/provider, set tasks/reminders.
6. Lifestyle & Nutrition Reviewed
1/3
Notes patient inactive and no RD/coach visits, but no reasoning effort to re-engage or understand preferences documented.
→ “Pt was inactive from 11/26/25-3/26/26 and no visits have been done with a health coach or RD, so no insights into lifestyle”
↑ Document outreach effort to understand barriers, explore specialty RD fit, and capture eating patterns/routine.
7. Clinical Goal
2/3
Goals exist for both billable conditions, appropriate, status noted as unchanged/not met, reviewed against current data.
→ “Weight Reduction goal... remains unchanged and is not being met... Blood Pressure Management goal... remains unchanged”
↑ Discuss how goals translate into daily/weekly home readings or behaviors for the patient.
8. SMART Behavioral Goals
0/3
No behavioral goal, no plan to set one, and no deferral/accountability goal documented.
↑ Set a SMART behavioral goal, or schedule a plan/timeframe to establish one, or document accountability goal.
9. Education
0/3
No supplemental education or materials provided despite identified concerns around BP, weight, and inactivity.
→ “I will send a summary and check in with the patient via chat.”
↑ Provide education materials on BP/weight/activity in patient-preferred format with rationale documented.
AI-MTPR (composer v1.5.2)
Concerns
• BP control: 30-day avg 139/91 above goal <140/90; Stage 2 readings 143/93 last 14d; clinical goal status NOT_MEETING per chat.
- Evening avg 135/89 vs morning 141/92 — AM-skewed elevation.
- 6mo avg 132/87 trending up to 139/91 this month.
- Only 5/14 days w/ readings — cadence below goal of 4 AM readings/week.
• Weight/BMI: BMI 55.9 per Apr 2026 chat, class III obesity; inactive several months per pt report.
- Prior Keto success 2021 (402→353 lb) — pt has demonstrated capacity for change.
- Activity lapsed — no current exercise routine documented.
• Med regimen complexity: 10 active meds incl. dual RAAS (losartan + lisinopril/HCTZ + lisinopril mono) — clarify with prescriber, possible duplication.
- Lisinopril 'discontinued' 2026-04-06 yet re-listed active 2026-05-14 — reconcile.
- Metoprolol on list but pt states not taking per 2026-04-10 chat.
- Frequency missing on 8 of 10 meds — clarify dosing schedule.
• Gout flare workup: New colchicine, febuxostat, ibuprofen, pantoprazole added 2026-05-18 following March hospitalization for gout.
- NSAID + ACEi + ARB combo — monitor renal function and BP closely.
- Pantoprazole likely GI protection for chronic NSAID.
• Lab staleness: Last CMP/lipids 2022-06-18 (~4 yr); lipids 2018-09-19 (~8 yr) — overdue given HTN, obesity, new gout meds.
- eGFR dropped 115→88 between 2018 and 2022 — needs recheck.
- HDL 23 (2018) well below >40 goal — needs refresh.
• Care engagement: 0 UC visits in last 12 mo; no lifestyle assessment on record; no clinical or behavior goals documented.
- Lifestyle assessment last touched 2025-03-25 (~15 mo) — overdue.
- CPAP adherence reported improved per 2026-05-14 chat — verify ongoing.
Section-level — Concerns
Non-Concerns
• Med tolerance: Pt reports no side effects from losartan 50 mg QD per 2026-04-10 chat; switched from lisinopril for renal preservation.
- Takes consistently 8–11 AM per pt report.
• CPAP adherence: Pt confirmed nightly CPAP use per 2026-05-14 chat; scheduled Dr. Zhang sleep study for replacement device.
• Self-reported insight: Pt has demonstrated prior weight-loss success with low-carb approach (402→353 lb in 2021) — receptive baseline for nutrition re-engagement.
Section-level — Non-Concerns
Plan Moving Forward
• Review BP trend with pt via chat — 30d avg 139/91 above goal; commend resumed monitoring after Feb gap.
• Task CA for updated CMP, lipid panel, A1C — labs >3 yr old; new gout regimen (febuxostat, colchicine, ibuprofen) + dual RAAS warrants baseline renal/K+ recheck.
• Clarify med regimen with prescriber: lisinopril mono vs lisinopril/HCTZ combo vs losartan duplication; confirm metoprolol active status (pt denies taking per 2026-04-10).
• Set clinical goals this cycle: BP <140/90, LDL <100, weight reduction target — none on file despite HTN + obesity dx.
• Set SMART goal: BP 4 AM readings/week × 4 weeks; chart in Behavior Goals. Pt receptive per recent chat engagement.
• Set SMART nutrition goal: return to <40 net carbs/day × 4 weeks per pt's prior successful pattern; chart in Behavior Goals. Pt agreeable per 2021 self-report of success.
• Discuss DASH + low-sodium principles via chat — supports BP avg 139/91 reduction; pair with low-carb framing pt already knows.
• Task CA to schedule RD_HC visit and refresh lifestyle assessment — 0 visits in 12 mo, assessment >15 mo stale.
Section-level — Plan Moving Forward
Overall
Rubric — AI-MTPR
23/27(85%)
Judge:
claude-opus-4-71. Vitals Trend Reviewed
3/3
Includes exact numbers, change over 6mo, AM vs PM split, cadence gap, and actionable next step.
→ “6mo avg 132/87 trending up to 139/91 this month”
2. Overall Health Concerns Identified
3/3
Major (BP, obesity, med complexity, gout, stale labs) and minor (CPAP, engagement) concerns identified accurately with context.
→ “BP control... Weight/BMI... Med regimen complexity... Gout flare workup... Lab staleness”
3. Overall Health Concerns Addressed
3/3
Each concern paired with appropriate action: chat review, CA task, prescriber clarification, SMART goals, lifestyle reassessment.
→ “Review BP trend with pt via chat... Task CA for updated CMP, lipid panel, A1C”
4. Medication Review
3/3
New gout meds noted, discontinuation discrepancy flagged, not-taking metoprolol flagged, missing frequencies flagged, duplication concern raised.
→ “Lisinopril 'discontinued' 2026-04-06 yet re-listed active 2026-05-14 — reconcile”
5. Labs
3/3
Identifies stale labs with dates, trends eGFR/HDL, rationale tied to new meds, tasks CA for follow-up.
→ “Task CA for updated CMP, lipid panel, A1C — labs >3 yr old”
6. Lifestyle & Nutrition Reviewed
2/3
Notes assessment 15mo stale, references prior keto success, plans refresh — but no current lifestyle fields reviewed in detail.
→ “Lifestyle assessment last touched 2025-03-25 (~15 mo) — overdue”
↑ Detail current eating patterns/routine or document reasoning for absence beyond noting stale assessment.
7. Clinical Goal
2/3
Identifies no goals exist and plans to set BP/LDL/weight goals; ties to vitals but goals not yet set or translated to daily readings.
→ “Set clinical goals this cycle: BP <140/90, LDL <100, weight reduction target — none on file”
↑ Discuss how BP <140/90 translates to daily/weekly home reading targets within this MTPR.
8. SMART Behavioral Goals
3/3
Two SMART goals with specific amount, frequency, 4-week timeframe, matched to patient history, charted in Behavior Goals.
→ “Set SMART nutrition goal: return to <40 net carbs/day × 4 weeks”
9. Education
1/3
Mentions DASH + low-sodium discussion via chat, but no supplemental materials, no patient-preferred modality noted.
→ “Discuss DASH + low-sodium principles via chat”
↑ Provide supplemental materials in patient-preferred modality across multiple concern areas with rationale documented.
Human RD vs AI — aspect-by-aspectRegex counts. Trends, not audit-grade.
| Aspect | RD | AI | Δ (AI − RD) |
|---|---|---|---|
| Structure | |||
| Total words | 264 | 544 | +280 AI more |
| Non-blank lines | 10 | 38 | +28 AI more |
| Concerns bullets | 0 | 20 | +20 AI more |
| Non-Concerns bullets | 0 | 4 | +4 AI more |
| Plan bullets | 0 | 8 | +8 AI more |
| Sub-bullets (indented) | 0 | 15 | +15 AI more |
| Clinical data citation | |||
| Numeric values | 54 | 96 | +42 AI more |
| BP-style readings | 11 | 10 | -1 RD more |
| Lab dates cited | 0 | 13 | +13 AI more |
| % values | 4 | 0 | -4 RD more |
| mg/dL values | 0 | 0 | = |
| Plan actions | |||
| SMART goal phrases | 0 | 3 | +3 AI more |
| Tasking phrases | 0 | 2 | +2 AI more |
| Education actions | 2 | 3 | +1 AI more |
| Lab cadence (q3/q6mo) | 0 | 0 | = |
| Specialty RD referral | 0 | 0 | = |
| Defer-to-next phrases lower = more action-this-cycle | 0 | 0 | = |
| Voice & tone | |||
| First-person 'I will' | 2 | 0 | -2 RD more |
| 'pt' abbreviation | 1 | 8 | +7 AI more |
| Soft-knowledge / chat | |||
| Chat citations | 0 | 5 | +5 AI more |
| Life-event refs | 0 | 1 | +1 AI more |
| Clinical domain coverage | |||
| Renal | 0 | 4 | +4 AI more |
| Glycemic | 0 | 1 | +1 AI more |
| Lipid | 0 | 3 | +3 AI more |
| BP / HTN | 3 | 10 | +7 AI more |
| Lifestyle terms | 0 | 2 | +2 AI more |