Clinical Care Classification System

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The Clinical Care Classification (CCC) System is a standardized, coded nursing terminology that identifies the discrete elements of nursing practice. The CCC provides a unique framework and coding structure. Used for documenting the plan of care; following the nursing process in all health care settings. [1]

Contents

The Clinical Care Classification (CCC), previously the Home Health Care Classification (HHCC), was originally created to document nursing care in home health and ambulatory care settings. [2] Specifically designed for clinical information systems, the CCC facilitates nursing documentation at the point-of-care. The CCC was developed empirically through the examination of approximately 40,000 textual phrases representing nursing diagnoses/patient problems, and 72,000 phrases depicting patient care services and/or actions. The use of the CCC has expanded into other settings, and it is claimed to be appropriate for multidisciplinary documentation. [3]

The CCC, capturing the essence of patient care, consists of two interrelated terminologies – the CCC of Nursing Diagnoses & Outcomes and the CCC of Nursing Interventions & and Actions – classified by 21 Care Components that link the two together. This merge enables a roadmap to other health-related classification systems.

The Clinical Care Classification (CCC) System is an American Nurses Association (ANA)-recognized comprehensive, coded, nursing terminology standard. [4] In 2007, the CCC was accepted by the Department of Health and Human Services [5] as the first national nursing terminology. [6] [7] The computable structure of the CCC System allows nurses, allied health professionals, and researchers to determine; care needs (resources), workload (productivity), and outcomes (quality).

History

In 1988 to 1990, Harriet Werley established the Nursing Minimum Data Set, which consisted of 12 variables: 8 variables focused on patient demographics and the remaining 4 focused on nursing practice. These were (a) nursing diagnoses, (b) nursing interventions, (c) nursing outcomes, and (d) nursing intensity. The Nursing Minimum Data Set became the basis for the nursing classification standards recognized by the ANA. [8] In 1990, the CCAIN was renamed the Database Steering Committee.

In 1991, the Database Steering Committee submitted to the Congress on Nursing Practice a resolution that NI be adopted as a new nursing specialty. This submission which was accepted, leading to the development of the Nursing Informatics: Scope and Standards of Practice [9] and the certification of NI specialists. In 1992, the Database Steering Committee developed the criteria, recognizing the first 4 of 12 nursing classifications/terminologies. One being the CCC System. Previously known as the Home Health Care Classification System, as nursing standards for the documentation of nursing practice using computer technology systems. [10] The ANA subsequently submitted the four of six classifications/terminologies to the National Library of Medicine for input into its developing Unified Medical Language System’s (UMLS) Metathesaurus.

In 2006, President George W. Bush issued an Executive Order (No. 13410) that every person in the country should have an EHR by 2014. In 2007/2008, the Healthcare Information Technology Standards Panel selected and recommended the Clinical Care Classification (CCC) System as the first national nursing terminology inter operable for the exchange of information among HIT systems. The CCC System was one of the standards in the first set of 55 national standards approved for use in the EHR, by the Department of Health and Human Services (AHIC, 2006) and the only national nursing terminology standard.

In 2020, HCA Healthcare became the new custodian of Dr. Virginia Saba’s Clinical Care Classification (CCC) System.

Major features

The CCC Model

The CCC Model depicts the documentation of patient care by nurses and allied health providers in any health care setting as an interactive, interrelated, and continuous feedback process. The CCC Model illustrates the relationship between the CCC of Nursing Diagnoses and Outcomes and the CCC of Nursing Interventions and Actions. The arrows are bi-directional indicating the continual flow and feedback among the three major concepts:

System framework

A nursing care component is defined as a cluster of elements that represents a unique pattern of clinical care nursing practice; namely, Health Behavioral, Functional, Physiological, and Psychological.
A clinical judgment about the healthcare consumer’s response to actual or potential health conditions or needs. The diagnosis provides the basis for determination of a plan to achieve expected outcomes. Registered nurses utilize nursing and medical diagnoses depending upon education and clinical preparation and legal authority” [11]
A nursing intervention is defined as a single nursing action – treatment, procedure or activity – designed to achieve an outcome to a diagnosis, nursing or medical, for which the nurse is accountable. [12]
Patient services are usually initiated as medical orders by a referring physician and reviewed by the admitting nurse. As part of the admission assessment the primary nurse also determines the nursing orders based on the signs and symptoms, diagnoses, and expected outcomes/goals; and together, form the plan of care that requires the nursing interventions following the nursing process. [13]
The CCC of Nursing Outcomes Version 2.5 consists of 528 concepts derived from the three qualifiers used to modify the 176 Nursing Diagnoses: Improve(d), Stabilize(d), or Deteriorate(d). These three qualifiers depict the Expected Outcomes and Actual Outcomes – totaling 528 nursing outcome concepts. The Expected Outcomes represent the goal of patient care in future tense as Will: Improve, Stabilize, or Deteriorate whereas the Actual Outcomes represent whether the goals were met or not met using the qualifiers in the past tense as Improved, Stabilized, or Deteriorated.

The CCC System consists of discrete atomic-level data elements that encompasses nursing diagnoses, interventions, and outcomes. The CCC is a nursing terminology specifically developed for computerization: e.g. electronic healthcare information systems (EHR), computer-based patient records (CPR), and Clinical Information Systems (CIS), from research which collected live patient care data. The CCC System describes the six steps of the nursing process:


The nursing process is the standard of professional nursing practice recognized by the ANA for clinical decision making in a coded, standardized framework. The CCC supports the exchange of nursing information and makes available for data retrieval and analysis in the electronic health record and health information record systems databases specifically linking nursing diagnoses to nursing interventions to nursing outcomes.

The Clinical Care Classification System was developed from a research study conducted by Dr. Virginia K. Saba and a research team through a contract with the Health Care Financing Agency (HCFA), [24] currently known as the Centers for Medicare and Medicaid Services (CMS). The objective was to develop a computerized method for assessing and classifying patients for the prediction of nursing resources needs and for evaluating the outcomes of care. "To accomplish this goal, data on actual resource use, that could objectively be measured, was collected and used to predict resource requirements" (Saba, 1995). [25] The CCC System was developed from retrospective research data from 8,967 patient records from a sample of 800 organizations randomly stratified by staff size, type of ownership, and geographic location. [26] The methodology was applied to a national sample of home health agencies that provided all services and products (Spradley & Dorsey, 1985). [27] Dr. Saba and the research team analyzed and coded the research from 10,000 patient records from which the team obtained more than 70,000 statements focusing on nursing interventions and actions provided to patients. Also used were 40,000 diagnostic conditions and problems describing patient care needs. [28]

The CCC System is a standardized framework consisting of four levels designed to allow nursing data to flow upward as well as downward. At the highest level the CCC System Framework consists of four healthcare patterns (Saba, 2007): [29]

Each represents a different set of Care Components. The second level consists of the 21 Care Components which serve to classify the two terminologies and define as a cluster of elements that depict one of four healthcare patterns. The third level consists of:

The fourth level is represented by the expected and actual outcomes 182 diagnoses each with one of three outcomes for Expected Outcome (Saba, 2007, p. 154):

And one of three outcomes for Actual Outcome:

The CCC System uses a five-character structure to code the two terminologies: (1) CCC of Nursing Diagnoses and Outcomes and (2) CCC of Nursing Interventions and Actions. The CCC coding structure is paced on the format of the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision: Volume 1, WHO, 1992. The coding strategy for each terminology consists of the following (Saba, 2007): [30] The graphic shows examples of the coding structure for a CCC diagnosis code and a CCC intervention code.

Illustration of CCC Code Structure CCC Code Hierarchy.jpg
Illustration of CCC Code Structure

The significance of the CCC is a nursing terminology that completes the missing link needed to address nursing contribution to healthcare quality. Nursing care may be the most critical factor in a patient’s treatment and recovery. [31] The partnership of nursing and technology is vital for designing nursing practice environments. [32]

The benefit of the CCC is the ability to represent the essence of nursing care in health information systems and applications during any patient care, transfer or transition. The CCC supports the mandate of accrediting organizations to reconcile patient-centered information (The Joint Commission, 2011) and supports the informational exchange and data integrity requirements of CMS and the Office of the National Coordinator (ONC) for meaningful use when patient data is exchanged by using the Nurse Process recognized for professional nursing.

The computable structure of the Clinical Care Classification (CCC) System in the public domain (copyright permission) promotes the system upgrades of existing electronic healthcare information systems. The system architecture of the CCC offers a return on investment with discrete atomic-level data to describe the impact of nursing care on care quality, productivity (workload), resources (staffing), and outcomes management. [33]

Applied uses

Nursing Practice Applications: [34]

Nursing Education Applications:

Nursing Research Applications:

Nursing Administration Applications:

Related Research Articles

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A nursing diagnosis may be part of the nursing process and is a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. Nursing diagnoses foster the nurse's independent practice compared to dependent interventions driven by physician's orders. Nursing diagnoses are developed based on data obtained during the nursing assessment. A problem-based nursing diagnosis presents a problem response present at time of assessment. Risk diagnoses represent vulnerabilities to potential problems, and health promotion diagnoses identify areas which can be enhanced to improve health. Whereas a medical diagnosis identifies a disorder, a nursing diagnosis identifies the unique ways in which individuals respond to health or life processes or crises. The nursing diagnostic process is unique among others. A nursing diagnosis integrates patient involvement, when possible, throughout the process. NANDA International (NANDA-I) is body of professionals that develops, researches and refines an official taxonomy of nursing diagnosis.

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<span class="mw-page-title-main">Nursing process</span>

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<span class="mw-page-title-main">SNOMED CT</span> System for medical classification

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References

  1. ↑ Saba, V. K. (2005). Clinical Care Classification (CCC) of Nursing Interventions. Retrieved December 15, 2005, from http://www.sabacare.com.
  2. ↑ Saba, V (1997). "Why the Home Health Care Classification is a recognized nursing nomenclature". Computers in Nursing. 15 (2): 569–576.
  3. ↑ Moss, JA; Damrongsak, M; Gallichio, K (2005). "Representing critical care data using the clinical care classification". AMIA Annu Symp Proc: 545–9. PMC   1560509 . PMID   16779099.
  4. ↑ "Nursing Practice Information Infrastructure - CCC". Archived from the original on 2011-07-27. Retrieved 2011-06-06.
  5. ↑ "Archived copy". www.hhs.gov. Archived from the original on 11 September 2007. Retrieved 22 May 2022.{{cite web}}: CS1 maint: archived copy as title (link)
  6. ↑ American Health Information Community Meeting 31 October 2006, "Health Information Technology". Archived from the original on 2011-10-17. Retrieved 2011-06-03.
  7. ↑ Alliance for Nursing Informatics (ANI), News of 12 February 2007 http://www.allianceni.org/docs/news012007.pdf Archived 2011-09-03 at the Wayback Machine
  8. ↑ (Werley & Lang, 1988. Identification of Nursing Minimum Data Set (NMDS).
  9. ↑ (ANA, 2008). Nursing Informatics: Scope and Standards of Practice. Sliver Spring, MD:ANA
  10. ↑ (Saba, 2011). Overview of the Clinical Care Classification: A national nursing standard coded terminology.
  11. ↑ American Nurses Association. (2010). Nursing: Scrope and Standards of Practice. Sliver Spring p.64
  12. ↑ Saba, V. K. (2007). Clinical Care Classification (CCC) System manual: A guide to nursing documentation. New York: Springer Publishing.
  13. ↑ "Sabacare: Nursing Interventions". Archived from the original on 2013-01-05. Retrieved 2013-05-12.
  14. ↑ Gartee, R. & Beale, S. (2011). Electronic Health Records and Nursing. Upper Saddle River, NJ: Pearson/Prentice Hall.
  15. ↑ Feeg, V. D., Saba, V. K., & Feeg, A. (2008). Development and testing of a bedside personal computer (PC) Clinical Care Classification System for nursing students using Microsoft Access, Computers in Nursing, 26 (6), 339-49.
  16. ↑ Parlocha, P. K.; Henry, S. B. (1998). "The usefulness of the Georgetown Home Health Care Classification system for coding patient problems and nursing interventions in psychiatric home care". Computers in Nursing. 16 (1): 45–52. PMID   9454994.
  17. ↑ Holzemer, W. L; Henry, S. B.; Dawson; Sousa, C.; Bain, C.; Hsieh, S. F. (1997). "An evaluation of the utility of the home health care classification for categorizing patient problems and nursing interventions from the hospital setting". Studies in Health Technology & Informatics. 46: 21–26.
  18. ↑ Moss, J., Damrongsak, M., & Gallichio, K. (2005). Representing critical care data using the Clinical Care Classification. In C. P. Friedman, J. Ash, & P. Tarcy-Hornoch (Eds.), American Medical Informatics Association 2005 Proceedings: CD-ROM (p.545-549). Washington, Dc: OmniPress, Omipro-CD.
  19. ↑ In Defense of the Desiderata, by James J. Cimino, Journal of Biomedical Informatics – JBI, vol. 39, no. 3, pp. 299-306, 2006
  20. ↑ Whittenburg, L (2009). "Nursing Terminology Documentation of Quality Outcomes". Journal of Health Information Management. 23 (3): 51–5. PMID   19663165.
  21. ↑ Saba, V. K.; Taylor, S. L. (2007). "Moving past theory: Use of a standardized coded nursing terminology to enhance nursing visibility". Computers in Nursing. 25 (6): 324–331. doi:10.1097/01.ncn.0000299654.13777.9f. PMID   18000428. S2CID   23142883.
  22. ↑ ANSI/HISB (1998/1999) Home health care classification (HHCC) of nursing diagnosis and nursing interventions. Inventory of Clinical Information Standards. Washington, DC: ANSI.
  23. ↑ Warren, JJ; Coenen, A (1998). "International classification for nursing practice (ICNP): most-frequently asked questions". J Am Med Inform Assoc. 5 (4): 335–6. doi:10.1136/jamia.1998.0050335. PMC   61310 . PMID   9670130.
  24. ↑ Saba, V. K. (1991). Home health care classification project. Washington, DC: Georgetown University (NTIS No. PB 92-177013/AS)
  25. ↑ Saba, V. K. (1995) A new paradigm for computer-based nursing information system: twenty care components. In R. A. Greenes, H. E. Peterson, & D. J. Proti (eds.), Medinfo ’95 Proceedings (p. 1404-1406), Edmonton, Canada: IMIA. Saba, V. K. (2002). Nursing classifications: Home Health Care Classification System (HHCC): An Overview, Online Journal of Issues in Nursing. Retrieved March 16, 2011 from http://nursingworld.org/ojin/tpc7/tpc7_7htm Archived 2011-07-27 at the Wayback Machine .
  26. ↑ Saba, V. K. (1992). "The classification of home health care nursing diagnoses and interventions". Caring. 10 (3): 50–57.
  27. ↑ Spradley, B. W., & Dorsey, B. (1985). Home health care. In B. W. Spradley (Ed.), Community health nursing. Boston, MA: Little, Brown & Co.
  28. ↑ Saba, V. K.; Zuckerman, A. E. (1992). "A new home health classification method". Caring Magazine. 11: 27–34.
  29. ↑ Saba, V. K. (2007). Clinical Care Classification (CCC) System manual: A guide to nursing documentation. New York: Springer Publishing.
  30. ↑ Saba, V. K. (2007). Clinical Care Classification (CCC) System manual: A guide to nursing documentation. New York: Springer Publishing.
  31. ↑ Gordon, S. (2005). Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care. Ithaca, New York, Cornell University Press.
  32. ↑ Improving the nurse work environment on medical surgical units through technology. RWJF Online. Retrieved April 24, 2011 from http://www.rwjf.org/pr/product.jsp?id=66949&cid=XEM_1177165 Archived 2011-04-26 at the Wayback Machine
  33. ↑ Saba, V. K., & McCormick, K. A. (2011). Essentials of Nursing Informatics (5th ed.). New York, NY: McGraw-Hill.
  34. ↑ Saba, V. K. (2012). Clinical Care Classification (CCC) System Version 2.5
  35. ↑ Warren, J. J., Connors, H. R., & Trangenstein, P. (2011). A paradigm shift in simulation: Experiential learning in Second Life. In. V. K. Saba & K. A. McCormick (Eds.), Essentials of Nursing Informatics (5th ed., pp. 691-631).
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