Claims-Derived Care Gaps

Rule-driven detection of diagnostic, referral, testing, and treatment gaps. Each finding includes a severity, suggested intervention, and claim-trace evidence.

Critical findings

3,378

Diagnostic misses

2,985

Referral leakage

207

Testing + treatment gaps

4,734

Detected gaps

22 rules · click a row for evidence

Severity	Category	Care gap	HCP involved	Patients	% cohort	Median delay
Critical	Testing gap	No KIT D816V test on record	Hematology/Oncology, Pathology	1,056	52.8%	266d	View →
Critical	Treatment gap	Recurrent anaphylaxis without epinephrine prescription	Allergy/Immunology, ED, Pharmacy	755	37.8%	-	View →
Critical	Diagnostic miss	Elevated tryptase without hematology referral	PCP, Allergy/Immunology	666	33.3%	90d	View →
Critical	Testing gap	No serum tryptase test on record	PCP, Allergy/Immunology, Hematology	575	28.8%	259d	View →
Critical	Diagnostic miss	Recurrent anaphylaxis without tryptase testing	Allergy/Immunology, ED	306	15.3%	172d	View →
Critical	Treatment gap	AdvSM patient without TKI claim	Hematology/Oncology, Pharmacy	20	1%	709d	View →
High	Diagnostic miss	Multiple ED visits before SM diagnosis	Emergency medicine	1,239	62%	238d	View →
High	Treatment gap	Therapy discontinuation without replacement	Hematology/Oncology, Pharmacy	942	47.1%	120d	View →
High	Testing gap	No bone marrow biopsy after suspicious pattern	Hematology/Oncology, Pathology	708	35.4%	120d	View →
High	Diagnostic miss	Flushing / urticaria pigmentosa without mast cell workup	Dermatology, PCP	282	14.1%	143d	View →
High	Treatment gap	Progression without therapy escalation	Hematology/Oncology	119	6%	90d	View →
High	Testing gap	No CBC differential in suspected advanced disease	Hematology/Oncology	110	5.5%	90d	View →
High	Referral leakage	Allergy/Immunology repeat visits without hematology referral	Allergy/Immunology	106	5.3%	60d	View →
High	Referral leakage	Dermatology UP without mast cell workup	Dermatology	43	2.2%	150d	View →
High	Diagnostic miss	GI symptoms repeatedly coded as IBS without tryptase or KIT	Gastroenterology	26	1.3%	274d	View →
Moderate	Diagnostic miss	Long delay between symptom proxy and SM diagnosis	All specialties	317	15.9%	823d	View →
Moderate	Testing gap	No DEXA despite bone pain or osteoporosis signal	PCP, Rheumatology, Endocrinology	305	15.3%	180d	View →
Moderate	Diagnostic miss	Bone pain / osteoporosis without SM evaluation	Rheumatology, Orthopedics, PCP	149	7.5%	229d	View →
Moderate	Treatment gap	High-burden ISM without symptom-directed therapy	Allergy/Immunology, Hematology	144	7.2%	653d	View →
Moderate	Referral leakage	Primary care repeat coding without escalation	Primary care	41	2.1%	870d	View →
Moderate	Referral leakage	Rheum/Ortho bone pain without mast cell evaluation	Rheumatology, Orthopedics	14	0.7%	240d	View →
Moderate	Referral leakage	GI pathway >24 months without tryptase	Gastroenterology	3	0.2%	1054d	View →