Clinical Care Classification System


The Clinical Care Classification 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.
The Clinical Care Classification, previously the Home Health Care Classification, was originally created to document nursing care in home health and ambulatory care settings. 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.
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 System is an American Nurses Association -recognized comprehensive, coded, nursing terminology standard. In 2007, the CCC was accepted by the Department of Health and Human Services as the first national nursing terminology. The computable structure of the CCC System allows nurses, allied health professionals, and researchers to determine; care needs, workload, and outcomes.

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 nursing diagnoses, nursing interventions, nursing outcomes, and nursing intensity. The Nursing Minimum Data Set became the basis for the nursing classification standards recognized by the ANA. 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 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. 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 Metathesaurus.
In 2006, President George W. Bush issued an Executive Order 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 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 and the only national nursing terminology standard.

Major features

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:
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, computer-based patient records, and Clinical Information Systems, 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, currently known as the Centers for Medicare and Medicaid Services. 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". 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. The methodology was applied to a national sample of home health agencies that provided all services and products. 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.
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 :
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 :
And one of three outcomes for Actual Outcome:
The CCC System uses a five-character structure to code the two terminologies: CCC of Nursing Diagnoses and Outcomes and 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 : The graphic shows examples of the coding structure for a CCC diagnosis code and a CCC intervention code.
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. The partnership of nursing and technology is vital for designing nursing practice environments.
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 and supports the informational exchange and data integrity requirements of CMS and the Office of the National Coordinator 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 System in the public domain 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, resources, and outcomes management.

Applied uses

Nursing Practice Applications:
Nursing Education Applications:
Nursing Research Applications:
Nursing Administration Applications: