Health Care System and Patient Classification
Patient Classification,Classification Process,Patient Classification and Nursing Care,Patient Classification Systems,Transformation of Classification.
Patient Classification
or categorization of patients according to a predetermined set of
characteristics. Until the late 1980s, this term was used almost exclusively to
refer to the classification systems for grouping patients according to their
requirements for nursing care and nursing resource determination and
allocation.
The exclusive use of the term to represent nursing systems became
inappropriate with the widespread development of other patient classification
systems (diagnostic related groups, case mix groups, and medical severity of
illness systems) to capture medical resource use and complexity as the basis
for hospital case costing.
continue to be used as equivalent terms. Connotations associated with these
terms from the perspective of medical status led to misconceptions, as neither
patient severity nor patient acuity correlates uniformly with nursing workload.
In contrast, patient dependency and nursing intensity have been offered as more
suitable labels to describe the intent of the patient classification systems
designed for nursing. During the past decade, however, a shift in the use of
terms has occurred.
Those patient classification schemes that form the basis
for the measurement of patients’ requirements for nursing care for the express
purpose of nursing resource determination and allocation are now referred to as
nursing workload measurement systems.
Classification Process
The process of classifying is defined as the ordering or arranging
of objects or concepts into groups or sets based on relationships among the
objects or concepts. The relationships can be based on observable or inferred
properties.
Classification theory also includes the distinction between
monothetic and polythetic classifications. Monothetic schemes refer to those in
which the classes established differ by at least one property that is uniform
among the members of each class.
In contrast polythetic schemes refer to those
in which the classes share a large proportion of the properties but do not
necessarily agree on any one property. Patient classification schemes for nurse
staffing are recognized as polythetic, and their development coincides with the
principles of this type (Giovannetti, 1978).
Patient Classification and Nursing Care
Work by Connor, Flagle, Hsieh, Preston, and Singer (1961) at the
Johns Hopkins Hospital during the 1960s introduced the concept of
classification into the study and measurement of nursing workload.
The critical
indicators or predictors of nursing care emanating from this work appear in
most contemporary nursing patient classification systems.
Patient Classification Systems
Two types of patient classification systems, prototype evaluations
and factor evaluations, were identified by Abdellah and Levine (1979).
Prototype evaluations rely on the creation of several mutually exclusive and
exhaustive patient categories.
These are graded in terms of an ordinal scale in
which the categories represent greater or lesser requirements for nursing
care. The patient is classified into the category that most closely matches the
profile or prototype description.
Factor evaluation systems employ the
selection of specific elements or indicators of care, representing either
unique care activities or clusters of care activities. Ratings on individual
elements are combined on the basis of a predetermined set of decision rules to
provide an overall rating that determines the appropriate category.
The end product of the two types of evaluations is essentially the
same. The difference lies in the method of rating; in prototype, the patient is
rated on a number of characteristics simultaneously, whereas in factor, the
characteristics are evaluated one by one.
Edwardson and Giovannetti (1994)
noted that many systems have been developed by vendors and consequently were
not fully described in the published literature. More systems have been
developed or modified at the institutional level and also not published.
Transformation of Classification
Transforming classification schemes for their ultimate use as
resource determination and allocation methods requires an estimate of the
nursing care time required of patients in each category. The literature is
replete with techniques for doing so and discussions of the central issues of
reliability, validity, and comparability.
Similar to nursing workload
measurement system research, research on patient classifications systems has
much to offer nursing practice, nursing administration, health care
administration nursing, and other institutional policy formation.
Information
on patient classification systems is available in professional, scholarly,
management, and policy journals as well as in texts and government reports.