Patient Classification In Health Care System

Health Care System and Patient Classification 

Patient Classification,Classification Process,Patient Classification and Nursing Care,Patient Classification Systems,Transformation of Classification.

Patient Classification

     Patient classification is a generic term referring to the grouping 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.

     With some peril, the terms severity and 1 acuity systems were and 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.