ETHICAL ISSUES IN A CAPITATED PROGRAM FOR FRAIL ELDERS

本提案的长期目标是描述 在一个创新的，为体弱的老年人提供资金的计划中出现的困境， 识别系统结构对伦理决策的影响。 因为所有的供应商都受到研究中所包括的影响。 这 调查是研究计划的第一步， 理解资本环境对道德决策的影响 决策;评估慢性病患者决策的有效性 和老年人;并确定将支持 护士及其同事的道德实践，在现实中， 新的经济和政治制度。 拟议的研究将在一个On-Lok复制点进行， 老年人全方位护理方案（PACE）。 步伐 该模式提供了一种替代传统的机构养老院护理， 改变了为体弱长者提供护理的模式。 当创新发生在医疗保健提供系统，新的道德 问题和困境将出现，现有的道德问题（即， 患者的安全和独立性），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， 在这种情况下的决策在很大程度上没有被研究过。

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.