A pilot study to explore the feasibility of using theClinical Care Classification System for developing a reliable costing method for nursing services.

While nursing activities represent a significant proportion of inpatient care, there are no reliable methods for determining nursing costs based on the actual services provided by the nursing staff. Capture of data to support accurate measurement and reporting on the cost of nursing services is fundamental to effective resource utilization. Adopting standard terminologies that support tracking both the quality and the cost of care could reduce the data entry burden on direct care providers. This pilot study evaluated the feasibility of using a standardized nursing terminology, the Clinical Care Classification System (CCC), for developing a reliable costing method for nursing services. Two different approaches are explored; the Relative Value Unit RVU and the simple cost-to-time methods. We found that the simple cost-to-time method was more accurate and more transparent in its derivation than the RVU method and may support a more consistent and reliable approach for costing nursing services.

Modeling, the essential step to consolidate and integrate a national NMDS.

How to develop a nursing minimum data set (NMDS) as a part of a nursing information system, which is itself a part of a health information system, this is the challenge presented in this paper and realized in Switzerland through the NURSING data project. The development of the CH-NMDS is not just a selection of data but a real conceptual work consisting in making the link between the information system and the terminology system and this for any level of aggregation. The building of a conceptual coherence between the collection of the data, their storage and their utilization for decision making was made by using the object modeling language, not for programming aims but statistical purposes. For example, the nursing phenomena and the nursing interventions are considered as classification concepts as well as sets of data.

A clinical care costing method.

The Clinical Care Costing Method (CCCM for the Home Health Care Classification (HHCC) System provides an innovative way to determine the cost of clinical nursing practice. This costing methodology consists of three major nursing indicators--Care Components, Actions and Outcomes. These three indicators require Clinical Care Pathways (CCP) to document, track, and code clinical care using the HHCC System. The clinical care costs and/or resources are derived from the time and frequencies of the Action Types for the specific nursing interventions performed by the different type of health care providers to achieve the Outcomes and resolve the Care Component that are used to classify nursing diagnoses/patient problems. This method can also be used to deter-mine the reimbursement for nursing care services retrospectively and once validated prospectively. The Clinical Pathway data provide the evidence that the nursing interventions achieve the desired outcomes.

The magnetic pull.

In this fourth of an ongoing series of articles, discover the major attributes of organizations that earn Magnet status through The Magnet Nursing Services Recognition Program for Excellence in Nursing Services of the American Nurses Credentialing Center.

Health promotive action and preventive action model (HPA model) for the classification of health care services in public health nursing.

BACKGROUND: There is a need for an expanded approach to develop knowledge of public health nursing as a sphere of public health. The aim of this paper was to construct a theoretical model for healthcare services in the area of public health nursing based on the analysis and classification of healthcare services used in public health nursing practice. METHODS: Patient records were examined using a qualitative research approach. The categorization and classification of the actions followed certain criteria. Three methods were used for verifying and modifying the concept. RESULTS: Of the identified categories 34 dealt with healthcare services, three with administrative services, and five with coordination. The six recognized domains of the healthcare services are health promotive services, health protective services, diagnostic services, therapeutic services, rehabilitation services, and terminal healthcare services. Using the public health approach, the Health promotive action and preventive action model (HPA model) was constructed in order to visualize where in the course of the process of health-ill health and developmental stages the public health nurses provide healthcare services. Health promotion and the levels of prevention are described on the operational and conceptual levels in this paper. CONCLUSIONS: The result is expected to have an important effect on how public health nurses conceptualize their field of knowledge. The classification reflects current public health policy by focusing on health promotion and illness prevention. The developed HPA model will support health service research.

The relationship among medical diagnosis, nursing diagnosis, and nursing intervention and the implications for home health care.

The purpose of this study was to identify the most commonly used medical diagnoses, nursing diagnoses, and nursing interventions for home health care based on 244 patient records. Nursing interventions were categorized into three groups: assessment, instruction, and other. The results showed that for the three most commonly used medical diagnosis groups--"infectious and parasitic disease," "disease of the circulatory system," and "neoplasms"--the most related nursing diagnoses were "alteration in mobility," "alteration in cardiac status," and "alteration in comfort: pain." The most used nursing interventions were "instructions." The results indicated that nurses identified patients' physiological problems mostly in relation to medical diagnoses, and teaching was the most frequently used nursing intervention in home health care.

The Nursing Outcomes Classification.

The Nursing Outcomes Classification (NOC) is a comprehensive taxonomy of patient outcomes influenced by nursing care. Each outcome is stated as a variable concept measured on a five-point Likert scale and includes a definition, indicators, and references. The classification provides outcomes that can be used across the care continuum to assess patient status following nursing interventions. The classification has a number of advantages, including being research-based, standardized, comprehensive, and flexible for clinical use. It was developed by a large research team that included clinical experts and has been subjected to testing.

Integrating Nursing Outcomes Classification in nursing education.

The importance of standardized language to communicate the contribution of nursing to the health of patients is beginning to be recognized and embraced by the profession. As we move to make standardized language part of nursing practice, it is essential to reach nursing educators who prepare future generations of nurses for the practice realities of the next century. The Nursing Outcomes Classification (NOC) is a valuable tool in nursing education and needs to be integrated into the curriculum at all levels. The current emphasis on evidence-based practice demands that graduates have the skills and mechanisms to measure the outcomes of nursing care.

Nursing data, classification systems, and quality indicators: what every HIM professional needs to know.

The nursing profession has developed a number of classification systems. What can HIM professionals learn from the processes and results? This article presents an overview of the major nursing classification systems and examines some of the national efforts to standardize nursing data elements.

Elements for a report card: one institution's experience moving from theory to trial.

The emerging computerized patient record, the movement toward a unified nursing language, and increasing accountability to the public for clinical outcomes are converging forces that require a coherent plan if nursing is to evaluate outcomes. The article describes a nursing service and school of nursing's approach and beginning experiences in identifying concepts and indicators that are useful to clinicians. These concepts and indicators have the potential to be embedded in a concurrent information system that would feed a data repository used retrospectively by clinicians and researchers. The article also discusses results to date and lessons learned.

Nursing Interventions Classification: a standardized language for nursing care.

Although nurses constitute the largest single group of healthcare providers in the United States, confusion exists about what nurses actually do. This article provides an overview of the Nursing Interventions Classification (NIC), which is the first comprehensive classification of nursing treatments. Quality management professionals will find the NIC useful in designing quality management programs, meeting Joint Commission standards, and planning redesign initiatives.

Development, testing and implementation of an emergency services methodology in Alberta.

Alberta was the first province in Canada to mandate reporting of hospital-based emergency services. This reporting is based on a workload measurement system that groups emergency visits into five discreet workload levels/classes driven by ICD-9-CM diagnoses. Other related workload measurement variables are incorporated, including admissions, transfers, maintenance monitoring, nursing and non-nursing patient support activities, trips, staff replacement, and personal fatigue and delay. The methodology used to design the reporting system has been subjected to extensive testing, auditing and refinement. The results of one year of province-wide data collection yielded approximately 1.5 million emergency visits. These data reveal consistent patterns/trends of workload that vary by hospital size and type. Although this information can assist in utilization management efforts to predict and compare workload and staffing levels, the impetus for establishing this system derived from its potential for funding hospital-based emergency services. This would be the first time that such services would be funded on a systemic, system-wide basis whereby hospitals would be reimbursed in relation to workload. This proposed funding system would distribute available funding in a consistent, fair and equitable manner across all hospitals providing a similar set of services, thus achieving one of the key goals of the Alberta Acute Care Funding Plan. Ultimately, this proposed funding methodology would be integrated into a broader Ambulatory Care Funding system currently being developed in Alberta.

A preliminary case-mix classification system for Medicare home health clients.

In this study, a hierarchical case-mix model was developed for grouping Medicare home health beneficiaries homogeneously, based on the allowed charges for their home care. Based on information from a two-page form from 2,830 clients from ten states and using the classification and regression trees method, a four-component model was developed that yielded 11 case-mix groups and explained 22% of the variance for the test sample of 1,929 clients. The four components are rehabilitation, special care, skilled-nurse monitoring, and paralysis; each are categorized as present or absent. The range of mean-allowed charges for the 11 groups in the total sample was $473 to $2,562 with a mean of $847. Of the six groups with mean charges above $1,000, none exceeded 5.2% of clients; thus, the high-cost groups are relatively rare.

Costing out nursing services: examining the research.

A review of 73 published and unpublished studies revealed a lack of agreement on how the terms "direct nursing care" and "total" and "direct nursing costs" are defined. A literature review and specific definitions for future research are presented.

Current Procedural Terminology (CPT) coded services provided by nurse specialists.

In this exploratory study, a random sample of nurses from nine nursing specialties was surveyed to identify which Current Procedural Terminology (CPT) coded procedures they perform and how frequently they perform them. CPT codes are used universally to file claims for physician payment. The sample included 74 school nurses, 67 enterostomal nurses, 53 family nurse practitioners, 43 critical care nurses, 43 oncology nurses, 40 rehabilitation nurses, 39 orthopaedic nurses, 34 nephrology nurses and 25 nurse-midwives. Specific questionnaires were developed for each specialty with codes identified by expert panels. The number of CPT codes ranged from 233 for family nurse practitioners to 58 for school nurses. The mean number of coded services performed by individual respondents ranged from 79 (FNP) to 18 (school nurses); individual respondents performed 0-162 codes. Supervision by physicians was very infrequent. Charges to Medicare in 1988 for the coded services included in the survey were $22,793,427.34 (aggregate allowable charges). The study provides some documentation of the degree to which nurses perform the same services and procedures for which physicians are being paid. If policy makers are serious about reaching innovative solutions to the problems of quality, access and cost, everything must be "on the table," including the contributions of nurses.