Clinical Care Classification
The Clinical Care Classification (CCC) started life in 1991 as the Home Health Classification System (HHCC). It was developed by Dr. Virginia Saga and colleagues at the Georgentown University School of Nursing(1) in the late 1980s and early 1990's.(2) At that time, its purpose was to provide a computerized means to objectively measure, and predict home healthcare needs for Medicare patients and to evaluate the outcomes of this care.(2) Its development was based on actual clinical documentation of narrative nursing notes from more than 8,900 records. These notes included over 45,000 nursing problems, and 70,000 interventions.(1) In 2003, the name was changed to the Clinical Care Classification and a new version of this terminology was made available that expanded the applicability of this terminology to not just nursing, but also other disciplines such as physical and occupational therapy, social work, and speech therapy.
Recognized by the American Nurses Association (ANA) in 1992, the CCC provides a framework for documenting three of the nursing elements in the nursing minimum data set: nursing diagnoses, interventions, and outcomes. It is comprised of two interrelated terminologies, 176 nursing diagnoses in 60 major and 116 subcategories, and 804 nursing interventions concepts.(3) They are classified into 21 Care Components under four patterns of care. (4) There are two interrelated terminologies in the terminology: 1) Nursing Diagnoses and Outcomes which are evaluated as improved, stabilized or deteriorated, and 2) Nursing Interventions and Action Types. There is no licensing fee to use the CCC.
It is harmonized with the International Classification of Nursing Practice (ICNP), Systematized Nomenclature of Medicine (SNOMED) and the Alternative Billing Codes (ABC). It has been accepted by Health Information Technology Standards Panel (HITSP) as a nursing standard.
References
1 Saba VK, Taylor SL. Moving past theory: use of a standardized, coded nursing terminology to enhance nursing visibility. CIN. 2007 Nov-Dec;25(6):324-31.
2 Saba V. Nursing Classifications: Home Health Care Classification System (HHCC). OJIN Accessed athttp://wwwnursingworldorg/MainMenuCategories/
ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/
Volume72002/No3Sept2002/ArticlesPreviousTopic/
HHCCAnOverviewhtml) . 2002 August.
3 Saba VK. About CCC. 2012 ; Available from: http://www.sabacare.com/About/?PHPSESSID=
b9e97459af41b2c80d194d7434aa7800
4 Saba VK. CCC Components. 2012 ; Available from: http://www.sabacare.com/Components/
Additional Resources for the CCC
Feng, R. C., Tseng, K. J., Yan, H. F., Huang, H. Y., & Chang, P. (2013). A preliminary study on the use of clinical care classification in nursing documentation data sets. [Validation Studies]. Comput Methods Programs Biomed, 112(3), 713-719. doi: 10.1016/j.cmpb.2013.07.019
A study that analyzed and organize the content coverage of the Clinical Care Classification to represent nursing documentation in the medical center in Taiwan. The results showed that 75.45% of their documented diagnosis terms can be mapped to the CCC.
Dykes, P. C., Dadamio, R. R., & Kim, H. E. (2012). A framework for harmonizing terminologies to support representation of nursing practice in electronic records. Nurs Inform, 2012, 103.
A paper that explores the feasibility of harmonizing the Clinical Care Classification system core interventions concepts with intervention concepts in the International Classification for Nursing Practice.
Moss J, Damrongsak M, Gallichio K. AMIA Annual Symposium Proceedings Archive. Representing Critical Care Data Using the Clinical Care Classification; 2005. p. 545–9.
Report of a study to evaluate the ability of the Clinical Care Classification (CCC) to represent data in an intensive care setting and recommend needed additions. Has a very informative desription of the CCC.
Moss J, Damrongsak M, Gallichio K. Representing Critical Care Data Using the Clinical Care Classification. American Medical Informatics Association; 2005; Washington, DC; 2005. p. 545–9.
A study that evaluates the ability of the Clinical Care Classification (CCC) to represent data in an intensive care setting and to provide recommendations for the expansion of this classification for its use in critical care.
Saba, V. & Feeg, V. Clinical Care Classification. 2006.
An excellent description of the CCC Version 2 along with coding information.
Taylor S. Foreword. In: Saba VK, editor. Clinical Care Classification (CCC) Manual. New York: Springer; 2007.
Part of the 2007 Manual of Clinical Care Classification (CCC). Has some relevant information regarding the need for standardized terminologies. Scrolling down will show some content for the manual.
Aslan GK, Emiroglu ON. Evaluation of the Applicability of the Clinical Care Classification System to the Care of Elderly Nursing Home Residents. Computers Informatics Nursing. 2013;31(4):178-188 doi: 10.1097/NXN.0b013e3182701028.
Report of a quasi-experimental design to descriptively evaluate the CCC for the care of elderly nursing home residents. The found that the CCC is useful to determine requirements and enable evaluation of the process.
Englebright , J., Aldrich, K., & Taylor, C. R. (2014). Defining and incorporating basic nursing care actions into the electronic health record. Journal Of Nursing Scholarship, 46(1), 50-57
Feeg VD, Saba VK, Feeg AN. Testing a bedside personal computer Clinical Care Classification System for nursing students using Microsoft Access. CIN 26(6):339-49.
This study tested the use of a laptop laboratory computer and the CCC for use in helping students document patient care. Found that it was helpful.
Feng, R. C., Tseng, K. J., Yan, H. F., Huang, H. Y., & Chang, P. (2013). A preliminary study on the use of clinical care classification in nursing documentation data sets. Comput Methods Programs Biomed, 112(3), 713-719.
Häyrinen, K., & Saranto, K. (2009). The use of nursing terminology in electronic documentation. Stud Health Technol Inform, 146, 342-346.
Moss J, Sava V. Costing Nursing Care: Using the Clinical Care Classification System to Value Nursing Intervention in an Acute-Care Setting. CIN, 29(8):455-60
The researchers used the CCC nursing interventions to demonstrate that the per-diem rate for costing nursing service "greatly understates the actual costs and fails to address the high levels of variability within and across units."
Saba, V. K., & Arnold, J. M. (2004). Clinical care costing method for the Clinical Care Classification System. Int J Nurs Terminol Classif, 15(3), 69-77.
Saba, V. K., & Taylor, S. L. (2007). Moving past theory: use of a standardized, coded nursing terminology to enhance nursing visibility. Comput Inform Nurs, 25(6), 324-331.
Saranto, K., Moss, J., & Jylhä, V. (2010). Medication counseling: analysis of electronic documentation using the clinical care classification system. Stud Health Technol Inform, 160 (Pt 1), 284-288.
Varzeshnezhad, M., Rassouli, M., Tafreshi, M. Z., Ghorbanpour, R. K., & Moss, J. (2014). Transcultural mapping and usability testing of the clinical care classification system for an Iranian neonatal ICU population. [Research Support, Non-U.S. Gov't]. Comput Inform Nurs, 32(4), 182-188. doi: 10.1097/CIN.0000000000000032
This is a report of a research to map nursing diagnoses and interventions observed in a neonatal ICU to the Clinical Care Classification and to the validation of the translation of the map diagnosis and interventions into Persian.
Created August 31, 2014
