About
Background
The Clinical Care Classification emerged from a research Project (HCFA No: 17C-98983/3) conducted by Saba and colleagues (1991) at Georgetown University School of Nursing. The research was designed to develop a method to assess and classify patients to determine the resources required as well as measures for their outcomes of care. To accomplish this goal, live patient data on actual resource use that could be objectively measured were collected and used to predict resource requirements.
The research consisted of a national sample of 646 health agencies, randomly stratified by staff size, type of ownership, and geographic location. They collected data on 8,961 newly discharged Medicare cases representing each patient's entire episode of home health care from admission to discharge. The research study collected data on all relevant variables - demographic, patient care services, visit dates, and discharge data - considered to be the possible predictors of home health resource requirements (Saba, et al, 1991). The statistical analyses focused on two distinct goals: (1) to conduct descriptive analyses of patient care and the services and (2) to develop a health care classification that could predict resource requirements and measure outcomes.
Data Collection
As part of the research data collection, two open-ended narrative statements were collected on nursing diagnoses and nursing services provided during the episode of health care. These two open-ended questions provided new information on health care services. The first question collected all nursing diagnoses and/or patient problems assessed as the major reasons a patient needed care. The disposition of each nursing diagnosis on discharge that was considered to be the outcome of care was also collected. The second question collected all skilled nursing services, significant treatments, activities, and interventions provided during the episode of care. Type of action associated with each intervention which represented another facet of the delivery of patient care was also collected.
Classification Design
In order to code and classify these narrative statements two unique schemes had to be developed. Initially the narrative statements collected from over a 1,000 patients were computer processed. The statements for both nursing diagnoses and nursing interventions were entered into a computerized database as a means of determining common terms. By using permuted "keyword sorts", like terms were sorted and clustered.
Hundreds of other "keyword sorts" were analyzed. The terms for the nursing diagnoses and nursing interventions were not only sorted separately, but also matched together by patient. By using this technique, along with statistical analysis and clinical judgment, two vocabularies were empirically developed. They were, tested, refined, and used to code the 40,361 narrative nursing diagnosis statements and 80,283 nursing service statements. Once the statements for the two questions were coded, the actual frequencies of the vocabulary terms were also statistically analyzed and grouped to create 20 care component classes. As a result, the original CCC of Nursing Diagnoses (version 1.0) and CCC of Nursing Interventions (version 1.0) terminologies were developed and classified by 20 Care Components. Together they provide a standardized coded framework for assessing, documenting, and evaluating nursing care holistically, over time, across settings, population groups, and geographic locations.