Osborne T, Lacy N L, Potter J F, Crabtree B F
Department of Internal Medicine, Section of Geriatrics and Gerontology, University of Nebraska Medical Center, Omaha, USA.
J Am Med Dir Assoc. 2000 Mar-Apr;1(2):51-7.
To determine the prevalence, composition, and function of ethics committees in extended care facilities in the United States.
Descriptive survey by mail.
A 5% random sample (n = 851) of nursing facility members of the American Health Care Association (n = 17,020). Most of these facilities (75%) are intermediate care facilities; the remainder include a varying number of skilled beds.
An eight-item questionnaire was sent to the randomly selected 851 extended care facilities. The questionnaire inquired about the existence of an ethics committee, plans for formation when applicable, composition of the ethics committee, and its function. Survey data was coded and merged with information on facility characteristics that are part of the American Health Care Association's database.
Of the responding facilities (n = 394), 34% reported the presence of a functioning ethics committee, with an additional 19% indicating definite plans for ethic committee formation. Forty-three percent expressed no interest in establishing an ethics committee, and 4% reported having had an ethics committee sometime in the past. The greatest proportion of committee time was spent in case review (39%) with lesser amounts of time expended in areas of policy formation (27%) and education (27%). Forty percent of the ethics committees performed two or fewer case reviews per year. Nearly all committees included the following disciplines in the membership: nurses (96%), physicians (95%), and social workers (89%). Facility administrators (77%) and clergy (70%) were frequently represented. Very few facilities reported representation by residents (8%) and Certified Nursing Assistants (2%). The Medical Director served as a committee member on 75% of the ethics committees, and in more than one-half of those instances, he/she was the sole physician on the committee.
Ethics committees are currently active in or there are plans for their development in more than 50% of extended care facilities in the U.S. this represents a very significant increase in prevalence during the last decade. This tendency to form ethics committee's may slow considerably in the future. Ethics committees exhibit considerable variability in structure and function.
确定美国长期护理机构中伦理委员会的患病率、组成和功能。
通过邮件进行描述性调查。
从美国医疗保健协会的17,020名护理机构成员中随机抽取5%的样本（n = 851）。这些机构中大部分（75%）是中级护理机构；其余包括不同数量的专业护理床位。
向随机抽取的851家长期护理机构发送一份包含八个问题的问卷。问卷询问了伦理委员会的存在情况、适用时的组建计划、伦理委员会的组成及其功能。调查数据进行编码，并与美国医疗保健协会数据库中有关机构特征的信息合并。
在回复的机构（n = 394）中，34%报告有一个运作中的伦理委员会，另有19%表示有明确的伦理委员会组建计划。43%表示对设立伦理委员会不感兴趣，4%报告过去曾有过伦理委员会。委员会大部分时间用于病例审查（39%），在政策制定（27%）和教育（27%）方面花费的时间较少。40%的伦理委员会每年进行两次或更少的病例审查。几乎所有委员会的成员都包括以下学科：护士（96%）、医生（95%）和社会工作者（89%）。机构管理人员（77%）和神职人员（70%）也经常有代表。很少有机构报告有居民（8%）和注册护理助理（2%）的代表。医疗主任在75%的伦理委员会中担任委员，在一半以上的情况下，他/她是委员会中唯一的医生。
目前美国超过50%的长期护理机构中伦理委员会活跃或有发展计划，这代表着过去十年患病率有非常显著的增加。未来组建伦理委员会的趋势可能会大幅放缓。伦理委员会在结构和功能上表现出相当大的差异。
