Page 90 - Encyclopedia of Nursing Research

CLInICAL CARE CLASSIFICATIon SYSTEM n 57

(1988–1991) to develop a methodology for elec- major and 126 subcategories] and 4 action
tronically assessing and classifying Medicare qualifiers: assess/monitor, perform/care,
patients to predict nursing resources and teach/instruct, and manage/refer). CCC of C
evaluate outcomes. The research study was nursing outcomes consists of 546 nursing
conducted by Dr. virginia K. Saba, Rn, EdD, diagnosis outcomes (182 diagnoses and 3
FAAn, FAMCI, LL, and her colleagues at the outcome qualifiers: improve, stabilize, and
School of nursing, Georgetown University, deteriorate) to code expected and actual
Washington, DC. The research study con- outcomes.
sisted of a national sample of almost 650 The CCC System consists of a four-level
health care facilities, which collected data framework that allows data to be coded at
on approximately 9,000 newly discharged multiple levels of abstraction and analyzed
Medicare cases representing each patient’s at multiple levels of granularity. The highest
entire episode of care from admission to level is four health care patterns: health behav-
discharge. The CCC System (version 2.1) ioral, functional, physiological, and psycho-
provides the documentation of nursing care logical, each of which represents a different
by linking nursing diagnoses, interventions, number of care components. The health care
and outcomes using the six standards of the patterns provide the framework for the third
nursing process recommended by the AnA level of the 21 care components—a cluster of
(2003). elements that depicts a holistic approach to
The CCC System was empirically devel- patient care. The care components are as fol-
oped from the computer processing of lows: activity, bowel/gastric elimination, car-
approximately 40,000 textual phrases rep- diac, cognitive, coping, fluid volume, health
resenting nursing diagnoses and/or patient behavior, medication, metabolic, nutritional,
problems and 72,000 phrases depicting physical regulation, respiratory, role rela-
patient care services and/or actions collected tionship, safety, self-care, self-concept, sen-
on the research study cases from live patient sory, skin integrity, tissue perfusion, urinary
records. The textual phrases were processed elimination, and life cycle. The 21 care com-
by computer using keyword sorts, statisti- ponent nursing classes were found to be
cal analyses, and other computerized tech- clinically relevant and the best predictors
niques, which provided the framework for of health care resources (Holzemer et al.,
classifying, coding, and indexing the textual 1997).
phrases to create the one system known as The next level consists of two interre-
the Home Health Care Classification version lated terminologies: (1) the CCC of nursing
1.0. It was revised in 2003–2004 from research Diagnoses and outcomes and (2) the CCC
study and feedback from “live” HIT systems of nursing Interventions and Actions. The
to form version 2.0 and the current CCC CCC of nursing Diagnoses and outcomes
System version 2.1. depicts patient conditions and/or problems
The CCC System, version 2.1, consists requiring clinical care by nurses and allied
of two terminologies: the CCC nursing health professionals. The definition of a nurs-
Diagnoses and outcomes and the CCC ing diagnosis is based on the definition used
nursing Interventions/Actions. Together, the by the north American nursing Diagnosis
two interrelated terminologies form one sin- Association (1992). An example of CCC
gle system classified by 21 care components nursing Diagnosis is Activity Alteration
and organized by 4 health care patterns. CCC (A01). Each nursing diagnosis is also paired
of nursing Diagnoses consists of 182 code with three outcome qualifiers (improve, sta-
concepts (59 major and 123 subcategories). bilize, and deteriorate) to depict an expected
CCC of nursing Interventions consists of 792 and an actual outcome representing the 546
nursing interventions (198 interventions [72 CCC outcomes. The qualifier digit represents