Home Health Care Classification (HHCC) Introduction
The evolution of home care services has necessitated the development of standardized classification systems to assess, document, and code home health care effectively. The Home Health Care Classification (HHCC) system is a comprehensive decision-support tool designed to capture the complexity of home health care delivery. It uses a structured approach to assess patient needs, document care, and classify nursing interventions across various settings. This system is instrumental in ensuring consistency, improving quality, and optimizing outcomes in home care.
Home Care Classification System
The HHCC system is a specialized classification tool that serves multiple purposes in home health care. It is designed to assess, document, and code home health care using two interrelated terminologies: the HHCC of Nursing Diagnoses and Outcomes, and the HHCC of Nursing Interventions and Actions.
The documentation method employed by the HHCC system tracks home health care over time, across different settings, and geographical locations. The terminologies are used to code and classify the care provided to patients, facilitating the analysis and comparison of clinical data. The HHCC system is based on a conceptual framework that utilizes the nursing process to evaluate patients holistically, ensuring that all aspects of a patient’s health are considered in care planning and delivery.
Home Care Systems Funded Program
The HHCC system was developed by Saba and colleagues at Georgetown University School of Nursing in Washington, DC. This development stemmed from the Home Care Project research study (1988-1991), which was funded by the Health Care Financing Administration (HCFA) under Cooperative Agreement No. 17009 8983/3. The study aimed to create a method for assessing and classifying home health Medicare patients to predict their need for nursing and other home care services and to measure their outcomes.
A national sample of 646 home health agencies (HHAs), randomly stratified by size, type of ownership, and geographic location, participated in the study. These HHAs collected retrospective data on 8,961 newly discharged cases, covering the entire episode of home health care from admission to discharge. This landmark study, representing the largest sample of HHA data in the United States, provided new insights and knowledge for the home health care industry.
Home Care System and Other Projects
The Home Care Project produced several valuable materials, including the HHCC of Nursing Diagnoses and Outcomes and the HHCC of Nursing Interventions and Actions. These terminologies were created empirically by processing approximately 40,000 textual phrases representing nursing diagnoses and patient problems and 72,000 phrases depicting patient care services and actions collected during the study.
The textual phrases were processed using computer-based keyword sorts, which led to the development of standardized coded labels. These coded labels were then grouped into 20 Care Components, which provide a framework for classifying, coding, and indexing the textual phrases for the two terminologies. The development of these materials has greatly enhanced the ability of healthcare professionals to systematically document and analyze nursing care provided in home care settings.
Home Care and Nursing Care Process
The HHCC terminologies are integral to the nursing care process, providing a structured method for assessing, documenting, and coding all six steps of the nursing process: assessment, diagnosis, outcome identification, planning, implementation, and evaluation. These steps align with the standards of nursing practice recommended by the American Nurses Association (ANA) in 1991.
The coding framework for the HHCC terminologies—the HHCC of Nursing Diagnoses and HHCC of Nursing Interventions—is structured according to the 21 Care Components. Each component is hierarchically coded following the International Classification of Diseases, Version 10 (ICD-10), developed by the World Health Organization (WHO). The system employs a five-character alphanumeric code that includes:
- First position: An alphabetic character representing the care component.
- Second and third positions: A two-digit code for a core data element (major category), followed by a decimal point.
- Fourth position: A one-digit code for a subcategory, if applicable.
- Fifth position: A one-digit code for a modifier.
This structured coding approach allows for detailed and accurate documentation of nursing care, facilitating the development of clinical care pathways and other applications that support decision-making and expert systems in healthcare.
Nursing Care System Design
The HHCC system’s design is highly adaptable, supporting the creation of clinical care pathways and other applications that make the terminologies useful. 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 electronic health records (EHRs).
Furthermore, the two HHCC terminologies have been incorporated into the MetaThesaurus developed by the National Library of Medicine for its Unified Medical Language System (UMLS). They are indexed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL), registered as an HL7 language, integrated into Logical Observation Identifiers Names and Codes (LOINC), and the Systematized Nomenclature of Human and Veterinary Medicine Combined Terminology (SNOMED CT). The HHCC terminologies have been translated into multiple languages, including Dutch, Portuguese, Spanish, Finnish, Korean, and Chinese, with further translations underway. Additionally, the original 20 Care Components were adapted by Ozbolt for developing the Patient Care Data Set (PCDS).
Coding, Strategies, and Methodologies
The HHCC system provides a comprehensive coding strategy and methodology for tracking clinical care, supporting decision-making, and offering standardized assessment data for mapping and predicting healthcare resources. It also provides critical information for quality management and evaluating various clinical care pathways.
The clinical information collected through the HHCC system allows for the aggregation of data to facilitate meaningful cross-population comparisons and inform administrative decisions regarding resource allocation. The HHCC system is versatile and can be used in various healthcare settings, including home health, community health, ambulatory care, hospitals, and long-term care facilities.
By utilizing the two terminologies, the HHCC system makes it possible to assess, document, code, index, and classify nursing care according to the 21 Care Components. This innovative system provides a robust structure and coding strategy for EHRs, enabling the identification of a nursing minimum data set and tracking the nursing care process across time, settings, and geographical locations.
Impact of the HHCC System on Home Care
The HHCC system significantly enhances the ability of healthcare providers to document patient care electronically at the point of care, moving away from traditional paper-based methods. The data collected can be used multiple times, allowing for better documentation and more efficient analysis. The system is free-standing and can be integrated into any home health system, with the capability to link electronically to other systems designed for professional and federal home health care reporting.
The HHCC system can be used to:
- Improve the Efficiency of Assessing and Documenting Home Health Nursing Care: The system provides standardized terminologies that simplify the documentation process, reduce errors, and enhance communication among healthcare providers.
- Develop Clinical Care Protocols and Pathways: The data generated by the HHCC system can inform the development of evidence-based care protocols and pathways, ensuring consistency and quality in patient care.
- Provide a Strategy for Evaluating Quality and Measuring Outcomes of Care: By tracking patient outcomes over time and across settings, the HHCC system allows healthcare providers to assess the effectiveness of their interventions and make data-driven decisions to improve care quality.
- Develop a Method for Costing Patient Care: The HHCC system provides valuable data that can be used to calculate the costs associated with different care pathways, helping healthcare organizations to optimize resource allocation and manage expenses.
Conclusion
The Home Health Care Classification (HHCC) system represents a major advancement in the documentation, coding, and classification of home health care. By providing standardized terminologies and a robust coding framework, the HHCC system enhances the ability of healthcare providers to deliver high-quality, consistent care across various settings and locations. It also supports decision-making, resource allocation, and quality management in home care. As healthcare continues to evolve, the HHCC system will play a critical role in shaping the future of home care delivery and ensuring that patients receive the best possible care.
For a complete description of the HHCC of Nursing Diagnoses and HHCC of Nursing Interventions, including classifications by the 21 Care Components, visit SabaCare.