ETHICAL ISSUES IN A CAPITATED PROGRAM FOR FRAIL ELDERS

这项提案的长期目标是描述 在为虚弱的老年人和 确定制度结构对伦理决策的影响。 因为所有的提供者都受到研究中所包括的影响。这 调查是研究计划的第一步，目的是 理解屈服环境对伦理决策的影响 评估慢性病患者决策的有效性 和老年人；以及确定将支持 护士及其同事在以下现实中的道德实践 新的经济和政治体制。 拟议的研究将在On-Lok复制站点进行 全面照顾老年人方案(PACE)。步调 Model提供了传统机构养老院护理的替代方案， 这改变了为虚弱的老年人提供护理的模式。 当医疗保健提供系统出现创新时，新的伦理 问题和困境将会出现，现有的道德问题(即 患者安全和独立性)，必须在新的背景下重新考虑。 进行这项研究的许多令人兴奋的原因之一是 在这种背景下的决策在很大程度上还没有人研究。

The long term objectives of this proposal are to describe the ethical dilemmas occurring in an innovative, capitated program for frail elders and to identify the effects of system structures on ethical decision making. Because all providers are influenced by the included in the research. This investigation is the first step in a research program aimed at understanding the impact of capitated environments on ethical decision making; evaluating the effectiveness of decision making for chronically ill and elderly persons; and, identifying processes which will support the ethical practice of nurses and their colleagues, within the realities of new economic and political systems. The proposed research will be conducted at a On-Lok replication site of the Program of All-inclusive Care for the Elderly (PACE) program. The PACE model offers an alternative to traditional institutional nursing home care, which has changed the paradigm for providing care to frail elderly persons. When innovations occur in a health care delivery system, new ethical questions and dilemmas will emerge and existing ethical issues (i.e. patient safety and independence), must be reconsidered in the new context. One of many exciting reasons for conducting this research is that ethical decision making in this setting has been largely unstudied.