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 for documenting the plan of care following the nursing process in all health care settings.
The CCC, capturing the essence of patient care, consists of two interrelated terminologies - the CCC of Nursing Diagnoses and Outcomes and the CCC of Nursing Interventions and Actions - classified by 21 Care Components that link the two together and enables mapping to other health-related classification systems.
The Clinical Care Classification (CCC) System is an American Nurses Association
(ANA)-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 (resources), workload (productivity), and outcomes (quality).
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
:
- Assessment
- Diagnosis
- Outcome Identification
- Planning
- Implementation
- Evaluation
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.
- Open Architecture
- Specifically designed for computer-based systems - EHRElectronic Health RecordAn electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
, CIS, and PHRPersonal health recordA personal health record or PHR is a health record where health data is curated by an individual user themselves. This stands in contrast with the more widely used electronic medical record which is held by institutions such as a hospital and contains data entered by clinicians or billing data in...
- Tested and applicable in ALL healthcare settings.
- Atomic-Level Concepts
- Approved as an interoperable terminology by the American National Standards InstituteAmerican National Standards InstituteThe American National Standards Institute is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States. The organization also coordinates U.S. standards with international...
(ANSI) Standards Development Organization (SDO) Health Level SevenHealth Level 7Health Level Seven , is an all-volunteer, non-profit organization involved in development of international healthcare informatics interoperability standards...
(HL7®).
- Conforms to Cimino criteria for a standardized terminology
- Coded standardized framework for electronic documentation, retrieval & analysis
- Codes based on ICD structure for information exchange promoting interoperability
- Designed for determining care costs
- Integrated in the Metathesaurus of the Unified Medical Language SystemUnified Medical Language SystemThe Unified Medical Language System is a compendium of many controlled vocabularies in the biomedical sciences . It provides a mapping structure among these vocabularies and thus allows one to translate among the various terminology systems; it may also be viewed as a comprehensive thesaurus and...
(UMLS) of the National Library of Medicine (NLM) and SNOMED CTSNOMED CTSNOMED CT , is a systematically organised computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, substances, etc...
- Integrated in the Cumulative Index to Nursing and Allied Health LiteratureCINAHLCINAHL is an index of English-language and selected other-language journal articles about nursing, allied health, biomedicine and healthcare....
® (CINAHL)
- Used in the Clinical LOINCLOINCLogical Observation Identifiers Names and Codes is a database and universal standard for identifying medical laboratory observations. It was developed and is maintained by the Regenstrief Institute, a US non-profit medical research organization, in 1994...
System for documenting diagnoses outcomes
- Tested as an international nursing standard based on the An Integrated Reference Terminology Model for Nursing approved by the International Organization for Standardization (ISO/TC 215ISO/TC 215The ISO/TC 215 is the International Organization for Standardization's Technical Committee on health informatics. TC 215 works on the standardization of Health Information and Communications Technology , to allow for compatibility and interoperability between independent systems.-Working...
:Health Informatics) in October 2003.
- Concept terminology with online source files so public and private organizations may harmonize nursing information formats for the cross organizational sharing of information.
- One of the contributed terminologies used as the basis for the original alpha version of the International Classification of Nursing Practice (ICNP®) developed by the International Council of NursesInternational Council of NursesThe International Council of Nurses is a federation of more than 130 national nurses associations. It was founded in 1899 and was the first international organization for health care professionals...
(ICN).
- Indexed to the MEDCINMEDCINMEDCIN, a system of standardized medical terminology, is a proprietary medical vocabulary and was developed by MEDCIN is a point-of-care terminology, intended for use in Electronic Health Record systems....
® terminology through a contextual hierarchy to the full array of medical terminology standards and concepts with intelligent prompting (IP). The indexing allows for the presentation and documentation of relevant clinical symptoms, history, physical findings, and diagnoses to the CCC nursing terminology from the Current Procedural TerminologyCurrent Procedural TerminologyThe Current Procedural Terminology code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among...
(CPT)®, Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental DisordersThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
(DSM-IV), ICD, LOINC®, RxNORM, SNOMED CTSNOMED CTSNOMED CT , is a systematically organised computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, substances, etc...
® and others for virtually any clinical condition.
The Clinical Care Classification System was developed from a research study conducted by Dr. Virginia K. Saba, EdD, RN, FAAN, FACMI and a research team through a contract with the Health Care Financing Agency (HCFA), currently known as the Centers for Medicare and Medicaid ServicesCenters for Medicare and Medicaid ServicesThe Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(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, which could objectively be measured, were collected and used to predict resource requirements" (Saba, 1995). 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 (Spradley & Dorsey, 1985). 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 as well as 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 (Saba, 2007):
- Health Behavioral
- Functional
- Physiological
- Psychological
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 defined as a cluster of elements that depict one of four healthcare patterns. The third level consists of:
- 182 nursing diagnosis concepts representing concrete patient problems
- 792 nursing interventions and actions (198 interventions each with one of 4 action types (assess, perform, teach, and manage) each depicting a unique single atomic-level concept
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):
- Improve or resolve patient's condition
- Stabilize or maintain patient's condition
- Support deterioration of patient's condition
And one of three outcomes for Actual Outcome:
- Improved or resolved patient's condition
- Stabilized or maintained patient's condition
- Deteriorated or died
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, WHOWhoWho may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
, 1992. The coding strategy for each terminology consists of the following (Saba, 2007): The graphic shows examples of the coding structure for a CCC diagnosis code and a CCC intervention code.
- First position: One alphabetic character code for Care Component (A to U);
- Second and Third positions: Two-digit code for a Core Concept (major category) followed by a decimal point;
- Fourth position: One-digit code for a subcategory, if available, followed by a decimal point;
- Fifth position: One-digit code for: one of three Expected or Actual Outcomes and /or; one of four Nursing Intervention Action Types.
- There are 4 CCC Action Types derived from the frequencies analyzed in the research study of 70,000 textual phrases described above.
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 durinng any patient care transfer or transition from one healthcare practice setting to another. The CCC supports the mandate of accrediting organizations to reconcile patient-centric information (JCAJCA- Organizations :* Josephite Community Aid, Australian charity founded in 1986* Jewish Colonization Association, created in 1891 to facilitate the mass emigration of Jews from Russia and other Eastern European countries* Joint Church Aid...
, 2011) http://www.jointcommission.org and supports the information exchange and data integrity requirements of CMS and the Office of the National Coordinator (ONC) for meaningful use when patient-centric data is exchanged across boundaries by using the Nurse Process recognized for professional nursing.
- Standardized professional documentation)
- Standardized data on nursing interventions for evidence-based practice and research
- Re-usable health data for cross-organization exchange comparisons
- Documented outcomes by nursing diagnoses
- Standardized quality outcomes comparisons by nursing intervention and action type
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, as well as productivity (workload), resources (staffing), and outcomes management.
External links
- Health Behavioral