Home Health Care Classification (HHCC) System

The Home Health Care Classification (HHCC) system is a decision-support system designed to assess, document, and code home health care, using two interrelated terminologies. Its documentation method tracks home health care over time, across settings, and geographical locations, whereas the terminologies are used to code and classify the care.

The HHCC system is based on a conceptual framework using the nursing process to assess, document, and evaluate a patient holistically. The HHCC system was developed by Saba and colleagues at Georgetown University School of Nursing, Washington, DC. It was developed from the Home Care Project re-search study (1988–1991) funded by the Health Care Financing Administration(HCFA; Cooperative Agreement No. 170098983/3) “to develop a method to assess and classify home health Medicare patients in or-der to predict their need for nursing and other home care services as well as measure their outcomes of care.” A national sample of 646 home health agencies (HHAs) randomly stratified by size, type of ownership, and geographic location participated in the study.

Home Health Care Classification (HHCC) System

The HHAs collected retrospective data on 8,961 newly discharged cases for the entire episode of home health care, from admission to discharge. This landmark study, which represents the largest sample of HHA data in the United States, provided new knowledge for the home health care industry.
The Home Care Project produced several materials, including the HHCC of Nursing Diagnoses and Outcomes and the HHCC of Nursing Interventions and Actions. The HHCC terminologies were created empirically from computer processing of approximately 40,000 textual phrases representing nursing diagnoses and/or patient problems and 72,000 phrases depicting patient care services and/or actions collected on the study cases. The textual phrases were processed by
computer, using keyword sorts from which the standardized coded labels were developed. The coded labels were also grouped into 20 Care Components providing the framework for classifying, coding, and indexing the textual phrases for the two terminologies.
The HHCC terminologies are used to assess, document, and code the six steps of the nursing process, its conceptual framework for documenting nursing practice. The standards of nursing practice recommended by the American Nurses Association in 1991 comprise these six steps of nursing process, namely: assessment, diagnosis, outcome identification, planning, implementation, and evaluation.
The coding framework for the two HHCC terminologies-HHCC of Nursing Diagnoses and HHCC of Nursing Interventions is structured according to the 21 Care Components. Each is structured hierarchically and coded according to International Classification of Diseases Version 10 developed by the World Health Organization. Each term uses a five-character alphanumeric code: (a) first position: an alphabetic character for the care component; (b) second and third positions: a two-digit code for a core data element (major category) followed by a decimal point; (c)fourth position: a one-digit code for a subcategory (if needed); and (d) fifth position: a one-digit code for a modifier.
This structure facilitates the design of clinical care pathways as well as other applications that make the terminologies useful. Itis also critical for the development of decision support and/or expert systems. The HHCC of Nursing Diagnoses and HHCC of Nursing Interventions have been “recognized” by the ANA as providing a valid and useful nursing language that can be used not only to classify nursing practice but also to document nursing care of patients in the electronic health record(EHR). Additionally, the two HHCC terminologies have been incorporated in the Met-a thesaurus developed by the National Library of Medicine for its Unified Medical Language System (UMLS), indexed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL). They are registered as an HL7 language, are integrated into Logical Observations Identifiers Names and Codes (LOINC), and the Systematized Nomenclature of Human and Veterinary Medicine Combined Terminology (SNOMED CT). Further, they are translated into Dutch, Portuguese, Spanish, Finnish, Korean, and Chinese, and they are being translated into other languages. The original 20 Care Components were adapted by Ozbolt for her development of the Patient Care Data Set (PCDS). The system provides the coding strategy and methodology for tracking clinical care for decision support, offers standardized assessment data for mapping and predicting health care resources, and provides information for quality management and evaluation of various clinical care pathways. The clinical information allows for the aggregation of data to provide meaningful cross-population comparisons as well as administrative decisions for allocating human resources. Further, the HHCC System can be used in home health, community health, ambulatory care settings as well as hospitals and long-term care settings.
The HHCC System consisting of two terminologies makes it possible not only to assess and document but also to code, index, and classify the nursing care according to the 21 Care Components. This innovative system provides the structure and coding strategy for the EHR, can identify a nursing minimum data set, and track the nursing care process across time, different settings, and geographic locations. The HHCC System facilitates the documentation of patient care electronically at the point of care instead of by the traditional paper-based method. The data once collected can be used many times, which allows for better documentation and more efficient analysis. The HHCC system is free standing and can be integrated into any home health system and linked electronically to any system designed to collect the data required for professional and/or federal home health care reporting. It can be used to (a) improve the efficiency of assessing and documenting home health nursing care, (b) develop clinical care protocols and/or pathways, (c) provide

the strategy for evaluating quality and measuring outcomes of care, and (d) develop a method for costing patient care. A complete description of the HHCC of Nursing Diagnoses and HHCC of Nursing Interventions, classified by the 21 Care Components including their definitions, is avail-able on the Internet at Http://www.sabacare.Com