Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
C

E

T

H

HAP
CHS
T P
E
CARE
....
b S sn . ae, hD
y ua E M zrP ..
Pei n & E
r d t CO
se
H an H a h ae yt sI .
elg el C r...
T e urn H A P (op aC nu r ses n o
h cr t C H S H si lo smeA ssmet f
e
t
H a hae rv es n S s mssr y rv e svrl
el cr Poi rad...
a ad oy o o et f ue i t metl s ,vin
n u i rcmp nn o p rl n r namui ao i
t
y su
c
dg
ayyi o muifmi r r i e t ay n
n l c r s...
P r pi o R set
ec t n f epc
e o
Q et n 17 n h sre fcs n h pt ns
u si s -o te uvyou o te ai t
o
e ’
pr pi o rset v ecdn o p...
T
O e teae i t o r T e ....hn e M o es
vrh l n h h us h CAREC anl ff ra
t g
,
mi i ttre ta rfl c a tn i sy i cag g
d g s fi l...
T e uso o te C H S uvy b u w ehr ai t
h q et n n h H A P sr ao t hte pt ns
i
e
e
pr i ta “ e tffd eeyh g hy o lt cnrl
ec v ...
ad o as n o te ai t n fmi r h tru h
n cmpsi frh pt n ad a l i tho g
o
e
yg
e
f
d cag. h CAREa H meM sr s ff rD Dso
i hre T ...
C

E

T

18 03809
-0 -4 -7 9
if@h an h a hcm
no el g el .
i
t o
w wh an h a haecm
w .el g el cr.
i
t
o

L e sn
i uo
k

H
Upcoming SlideShare
Loading in …5
×

HCAHPS, The Patient Experience, and C.A.R.E.

734 views

Published on

A paper that examines the connection between the questions on the HCAHPS survey and hospital noise, and how a therapeutic tool like The C.A.R.E. Channel can help improve the patient experience.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

HCAHPS, The Patient Experience, and C.A.R.E.

  1. 1. C E T H HAP CHS T P E CARE .... b S sn . ae, hD y ua E M zrP .. Pei n & E r d t CO se H an H a h ae yt sI . elg el C rSs m , c i t e n A s at bt c r A n may te fc r te 1 uso H A P mo g n oh rat s h 3 q et n C H S o, i sr y pci l l k a te ni n n o cr uv sei ayo s th evo met fae e f l o c r wt n i ad l nnsb i te o cs ns i o e n c ales e g h tuht e h s e i n o nme . o ee pimaae n,o a dH w vr a , n ngmetcmmu i t n n ai , c o cmpe es n f i hrent co s r ec o rh ni o d cag i r t n ae ah o s su i i atd y ni n n.h w i ppr xmi s mpc b evo met i h e ae ea n e r Ts t e te o nco b t en h H A P q et n ad h cn et n ew e te C H S uso s n i i te u i revo metad o a h rpuito h ad oy ni n n,n h w teaet o l t r c T M le h CAREC anl cn e i rv soe. i T e ....hn e a h l mpoe crs k p
  2. 2. T e urn H A P (op aC nu r ses n o h cr t C H S H si lo smeA ssmet f e t H a hae rv es n S s mssr y rv e svrl el cr Poi rad yt )uv poi seea t d e e d i i ti o h pt n epr nei l i : n g sn te ai t xei c, c d g sh t e e nu n •H wpt ns eci te rl i siwt toe h o ai tpr v hi e t nh i h s w o e e e r ao p h cr frhm aeo te •H wpt ns xei c te uly fae n cr g o ai tepr ne h q ato cr ad ai e e i n te rci hyee e v •H wpt ns eci te ni n n iw i te ae o ai tpr v h evo met h h hy r e ee r n c crd o ae fr •H wpt ns eci te o n o d i a ep i d o ai tpr v hi w cn io s xln e ee r tn ae t te b te crg es o hm yhi aei r r v Wi iec o teesustee r moe pc c n t n ah fhs i e,hr ae r sei ad h s fi d tid uso s n h sr yht rb i o h pt n eae q et n o te uv ta po en te ai t l i e t e epr ne I lin n o te b t o ncsai xei c.mpc imay fhm,u n t eesr e it l y s tditempco te hs aevo met t e , h i at fh p yi lni n n. a s c r T e o n ai o H ai h Fu d t n f e l g o n E v o met n i n ns r Ihr oknai teo n ai frh rlo te op a n e w ril n h fu dt n o te o fh h si l yg o e t evo met te d 9h etr F rne i t gl ni n n i h mi1t C nuy l ec Ng i a r n ,o hn e s td l r ta pt ns r i ro e b te i es r t e c al ht ai taempi nd yhil sfis a e y e s rl n t adte,yh “ c ro ta fr e i l e te S e n ,hnb te s ko m”htut r o tshm.h i h sa w oe hto r om,euyad ai y ee ri l te rt ta cl , r b at n vr tw r ctat h of , e ic o w l e g n rs rt e rcsta moe a ai trma e- i ad et ai poesht vs pt n f l n b o v e o s t o d es t ta o ha h Ng t gl 16 ) ali t e f i ae o ht f el (i i a ,8 0. r n a s t hn e E y o hn e te td o h ma dvl metNg t gladesd ht h s y f u n ee p n, i i a d rse w a u w so e o s ee tempco mo oo y n b rd m. a t b cni rd h i at f n tn ad oe o d IN ts n us g se rt,T ay u a o n r ,rn n oe o N rn ,h w oe“o n b t n l us o a i d e o pt n,h d ge w u b q i i o ci b t w i l ai tte ere o l e u en ne al o h h d e d t c v e c te evs fh s k u e f mse g h sme aste h nr o te i sff rr ei te a w l,h e c o n l sme ei ,h sme uru d g d r g …cn nmet ” a ci gte a sr n i s ui a o fi e n… l n o n n (i t gl 16 ,.9. Ng i a ,8 0p1) hn e F r i t gl te o Ng i a ,h hn e pt n’ xei c w s ai t epr ne a e s e te o d tr nn o h sl eemi t f e a w adfi e n i . ht e ns o e s S e l adesd h caeg o su d y ri ta ay h a o d rse te hln e fo n b w in ht n s l tg su d htassati t nu cr i yapees n o n ta cue “nip i ,net n ,p rhni , c ao at o w in ,xett nad er fupi ” a gsh pt n. a i epc i ,n fao srre dmae te ai t tg ao s e F r i t gl te ai t epr ne a te o o Ng i a ,h pt n’ xei c w sh sl hn e e s e e d tr nn o w a d fi e n i .h w u hv are ta eemi t f ht e ns o eS e o l ae ged ht a s d o j t e o meee w r scn ayo eci d b cv vl l l ee eo drt pr v ei u vs ee l d esmehn asu d w r i otn t te ere o ns; cai lo n s eemp r to h d ge u c a te d tre a ai tte o n o melatw r a i u hy iub d pt n;h su d f acr ee nn l s e s st t a ai ti e hy ee ad ctat te rcvr;n o pt n s c te w r hrl ri l hi eoeyad e n y ic o r vcu c aesh u b emi tdS ei ayse rt au m l nrso l e l n e .pc cl,h w oe e d i a fi l ta “n eesrn i w sh c e sasne fae A htu ncsay o e a te r l t bec o cr. t s ue ” te a t ,h e hs e temp r ne f u t n h sme i se mp ai d h i ot c o q i ad me z a e rseto te u ei ta cu o lb w r nd y epcfrh sff r g hto l n e os e b n d y e bi t v i o s eai .h p th rso s i y n h crg eso n ni rt nS e u te ep nil o te aei rt c d o ati t w a w u b d tri ad o n z o nip e ht o l e iub g n t mimi r ca d s n i e emi t tee t sos l n e hs s esr i a r . It d c g .... nr ui CARE o n I19 , elg el C rS s msnrd cd h fis n 9 2H an H a h ae yt i o ue te r i t e t t evo metlrga n fr ai te v i ,h ni n napo rmmi o pt n tl io te r g e esn C ni o s mb n R l ai E vo metCARE) o t u u A i t e xt n ni n n (.... n e a o r l noh canlCAREadesd eeacaegs o hn e ....d rse svrlhln e cmmo t te . h si lni n n,o o w i hd l ay en op aevo metsme f h h a a ed b e t r c r i ni d n ohryto o . oo i te ees f d t e ad tes e t cme F lwn h tnto e fi l g Ng t gl moe urn s d sn h fi lo evo metl i i a , r cr tt i ite e n ni n na hn e e ue d r T pyh l y n ha hae ei ,h CA ..hn e M sco g ad el cr d s nT e .REC anl o t g sr sh pt n o a “s ed d bs oe teu 2-o r ev te ai t n n a- e e ” ai vrh fl 4h u e e n s l ami i dyT e i ai gs s te r c l o b p i d s o a.h v ul sn s mae ue h pi ie f i hi np s o l a (eet Wio ,9 3ad n esltat n o lin K lr& l n19)n u i r at co t a li l s v a r i lv g ti sa w l sh chrne f aual dcps l g h g,s e a te o eec o ntrl n sae a n n l a o wt i h 1
  3. 3. a ad oy o o et f ue i t metl s ,vin n u i rcmp nn o p rl n r namui ao i t y su c dg ayyi o muifmi r r i e t ay n n l c r s a l o b sd o n o e rs c i a a gnrt ncl r,tn i o rli .hr ae l n vcl eeai ,u ueeh it reg nT ee r a o o oa o t cy io s l i ,l nt gag ae o fs n ro n i y c emi i l ug cnui o cg iv rs i a n n o te d mad. e ns G i bc t Ng t gl b teat ur r fh 1t o g ak o i i a ,yh l q at o te 9h n hn e s e , e t r C nuyse a asr d ht op aevo metw r t etr h hd set ta h si lni n ns ee o poi fr n o g bevt n fh pt n adnet n rv eo o g i o sr i o te ai t n i co d n ao e f i cnrl h pyh l i ln e t nltt o te ai t o t , e sco g aad moi as e fh pt n ot oc o a e tru h hi ecpi s f ht a hp ei t ad ho g te pr t n o w a w s apn g o n r e o n ao n te ad h rlo te ai t ni n n a ta ru d hm,n te o fh pt n evo met sht e e r w i i ome a o teeNg t gl 16 ) h a o h hn r d l fhs (i i a ,8 4. e l c f l hn e S s p i e t vr ta te ni t t mo oo y n rsln o td o ai y sh at oe o n tn ad eu i n e d tg b rd m, h h h p se i rae piad u ei . oe o w i se oi dn esd a n sff r g c t c n n Ng t glw n fr e t syht vr tw r t b i i a etut ro a ta i ai y ee o e hn e h f e poi di sb s wvr t a fscag goerv e , mut e l ai y sathn i ,vr d t o e, n d mad gmae, n ug,co s o lw r n h f s e n i i gsl g aeat n w u os ter n a i d e u s ai ad a a ed svr ipt ns h ae t t n n pi l ay eeen ai tw o r r o n r e h si le (i t gl 16 ) h ste ed o snivl op azd Ng i a ,8 4. u,h ne fresi y ti hn e T te pcd ai y n b at ad s ta w so ti rte ae vr tad euy n mui ht a soh g ahr e , c n ta i in ,ea teo n i s n ad fr rd c g hnn t gb cme h fu d g t drso po ui ci n a n T T e ....hn e M. h CAREC anl U le stl io bodat d cnetf mi nk mote v i racsme i o tn, o t i esn a r s te cnet nCAREhs d rse te esi ne s fh o cpi ,....a adesd h sniv ed o te o mot ct pt n p p l i w i sl e g p rpi eo saue ai t o u t n he tl i apo r t fr e ao l ib n a a pt nsT e hln e o h hee o me i t nh h l ai t h caegs f i l l f d ai ,i l e . l g vs c o g au ycg iv i a meta w l s i r nai ae ci,o n i mpi n,s e a d oi tt n r t te r l s e o cmmo ite op astn . ai trcvr g rm o nn h h si let gP t nseoei f t i e n o sreyf ma eratc o s oef mi et n r ugr r , o hat t k rt k, o n co o a r r f i p emo i rq i a evo metht rso s e nu n , u e n ni n n ta i ep ni , ae r r s v rsi tad etrt e ei n,n rs ai . l e o v N tr ad s , hn rd cd o ev tip p l i ad aue n mui w e po ue t sr h o u t n n c e s ao tee iu tne,rnfr te o o tenro pt n hs ccms cst s msh rl fh i o m ai t r a a o e e tl io f metr in t teaet. i t gls e v i r net n g o hrpui Ng i a ’ esn o ai c hn e oinli cv rgri te ai o smu t n o r i d et e ead g h pc g ft l i fr ga r i n n i ao pt nstgte wt nw rtd sn ni n na ai t o ehr i e e s i ievo metl e , h ue r pyh l y n h ma dvl met rv e s o g i co sco g ad u n ee p n poi d t n d et n o o d r r i ite rd co ad d i s n ad ta t tidyg i n h po ut n n e in t drshto h a,u e i tg a s d T M te uly n e et ees f h CAREC anl . h q atad ff cvnso T e ....hn e i i P t nseoei f m ai trcvr g r e n o , o h at t k r a sreyf ma eratc o ugr r s oef mi et n r t k, o n co o r r f i p emo i rq i a nu n , u e n ae r evo metht rso s e ni n n ta i ep ni , r s v rsi tad etrt e ei n,n rs ai . l e o v CARE M es C H S .... etH A P Arv wo te 1 uso snl e ite C H S uvy ei fh 3 q et n i u dn h H A P sr e i cd e eel te t ou o i e ta ae h cr o te s c s rva a hmaifcs nsusht r te oe fh i h si lxei c.hs q et n ae nw rdn n op aepr neT ee uso s r as ee i t e i rt setfrn pt nso o o lrcl ht apnd o er pc oc g ai tt n t n ea w a hp ee t o , i e y l te b to l rle h motri lvns hm,u t a o ev te sctaeet s i ic . Whe c o w a g e o d r g h si lai in t i muh f ht o s n ui a op azt ns o l n ti o rcld r oe ,h mot o nn mo nse iite eae o n tdte sp i at metrma n h l g n pt n’ moygin men g vri . C H Sset ai t me r a i e s , n g ai oe t H A P isn n me t aad mi d a lg f ai twti2 h usoo i o rn o z smpn o pt ns i n 4 o rflwn e i e h l g te d cag.vn h at fsi tee uso sevso hi i hreEe te co ak g hs q et n sr t rs n i e a e te at o q et n o te uvy r o t me o l rh ps S me uso s n h sr ae uc s f t . i e o te eeazd ai t xei c.o ea l te nl h gnrle pt n epr neF r xmp ,h fi a i e e e q et n rgri te uly fh h si ln w ehrh uso sead g h q ato te op aad hte te i n i t pt n w u rcmmed h h si l ohrflwmoe ai t o l eo e d n ti op at tesoo s t o l r sei q ei . te q et n l k t o pt ns nee pc c ur sO hr uso so a h w ai tetrd fi e i o e te op aad hr te w n flwn d cag. 21, h h si ln w ee hy etoo i i hreI 03 t l g s n fu moe uso s ee d e ta d awt te o r r q et n w r ad d ht el i h i h d mo rp i o te ai ti o ,d ct nrc,n e gah s fh pt n: cmee uai , ead c e n o a l g ae a ug . n 2
  4. 4. P r pi o R set ec t n f epc e o Q et n 17 n h sre fcs n h pt ns u si s -o te uvyou o te ai t o e ’ pr pi o rset v ecdn o p yias n n r s ec t n fepcei ne ih w hs i ad us e o d cn e adesd hm,o te cmmu i td i te ad h d rse te h w hy o n ae wt hm,n te c h rgr wt w i te w r t ae . h i l e pt ns ead i h h hy ee r td T i n u s ai t h c e s cd e ’ cpcyo uy n es n w a w s apn g o hmad aai t fl u d r ad ht a hp ei t te n t l t n tempct n byn te op as yC mmu i t n h i lai s eo d h h si lt .o i o t a n ai , c o cmpees nad ai flio u ae ah eed n o rhni ,n men gud l e r ec d pn et o n ag o te ni n n iw i po lae n ae .o ea l n h evo met h h e p r eggdF r xmp , r n c e e ia o y ni n n,h tn r f io u tn so i i n n i evo mette eo o d l e ed t ren s r ag s vl ad e t i dFr e te bi frn l r o me n b s a e .ut r h ai yo a e el u rn h, l t d y pr n o o rhn w a ib i sit te ee i h es t cmpeed ht e g a o hm,vnf e o s n d t l g aesi le , ma s i lcmpo sdn cat a ug is i dr i h h o rmi ia hoi n mpfi e n g y e c ad l trd u i revo met n c t e ad oy ni n n. ue t r el i te rn o cmmec l l io w e isev g an rat e s n hnt srn i e vi i i R p c g h do e fo o lt fi te i ad l d h t nprny fn n o lh t y l me n c u te r saec o a o a evo metht satrd i su d o te op a ni n n ta i pt e wt o n s fh h si l r s e h t, CAREpoi s soh gcniet u i rad i a ....rv e a o ti ,o s tn ad oy n v ul d n s t s bcgo n ta iapo r t freoeyR te ta akru d ht p rpi eo rcvr ahrhn s a . cmpt g i i otn d l u ad o o ei wt mp r t io e n cmmu i t n, n h a ag n ai s c o CAREmak b t cni o so n s n ert n i s .... ss oh o t u u su d ad r i o e. n ac s D r g h op as , o f d us / cosi e n s t a e d ed s “ ui tih si ltyh wotn in r s otrltn crfl t yu” aeu y o o ? l T nc i b t en ao T e .... h n e M e h ne cmmu i t n ew e h CAREC a n l n a cs o crg es n p t ns y ae i ra d ai tb : v e 1 Makn cniu u su d a dert n i sh ta . sig o t o s o n s n r i os ta cn n ac e itr p cn est n. ner to vr i s u ao 2 Po iigasohn ,o s tn a dtr a dvsa . rvdn o tig cni e t u i y n i l s o u b cgo n ta cl p t ns n ao sh m t ak ru d h ta ms ai ta d l w te o e l fcs n h ts e g a . ou o w a ib i si n d T e ni n n cmmu i tsh i et n fh ha hae h evo meto r n ae ten ni o te el cr c t o t ogn ai ad e ette aai o amis aos n rai t n n rfl c h cpcy fd n t trad z o s t ir s fft raz te n vrapo ss d rgri h h t o ele h may eblrmi mae ead g i a i e n g q atcr. uly ae i A aalt pt ns n n n o g airte ta o l vib o ai to a o g i bs ahrhn n l e e n s y d r gnevni s n mo i r gCARE ui i r t n ad n oi ,.... n t e o t n sp ota u ue f esncnee cr. u p r cl r o pr - trd ae s t o e E v o met f ae ni n n oC r r Q et n 8 n 9ou drclo te ni n n o u si s a d fcs i t n h evo met f o e y r cr,si h wotn h h si l o ad aho mw r aeak g o f te op ar m n btro ee n e t o kp c a ad o otn h pt n epr ne q i a etl n n h w f te ai t xei cd u t t e e e e e n h.hs q et n hv d ee i lai s F s “et i t ee uso s ae epr i t n. it kp g T i mpc o r, c a”mpe ta te op aro w sed d ota l n i lshth h si l m a tn e t,ht e i t o h ueepretrd h ro cekd ntcn io ad o skees nee te o m,hce o i o d i n s tn ta o te aho m,n ma ti dth h uly n n ht fh btro ad i a e i i q ato a n n sg i o g i bs . n o g ai n s f t ns ae o l rai ad oiv ou d r g h p e t v te n I ai thv n a ent e n p si fcs ui te may o rta te ae w k,hy ise n hamoe n h ushthy r a aete wl e ad er r l ta ay tffme e ada Ng t glad hn l c hn n s a mb rn ,s i i a n te Me a hn e z l e p i e o tte wl n ti o te d cmfrad a r o td u,hy io l h k fhi i o ot n t n l y n rs ccms ne ( l c &Pr ,95Ng t gl 16 ) hy iu t csMe ak er 17; i i a ,8 0. e r a z y hn e T wl oi s l ti o te ray uti ad rw i in te ma s n n h pi c cr n n bo n h l c la s v as s l k ite ei te.hy in te at cn ta hv e sn h ci g isT e wl oi w s asht ae a l l n l c e r y l c n t en mpi . n ,hi a lme es in te vn o b e e t dA dte fmi mb rwl oi ee e moe r. T i n T e ....hn e M in t sbtueo tn i t te h CAREC anl s o a u stt fred g o h ro H w vrt a oiv fcsadt rv e pt ns o m. o ee is p si ou,n i oi s ai t ,i te p d e wt ko l g ta te ae o a n. i n we e hthy r n t l e h d o N x,q i a n h”s o ao tineR te ii q at et“u t t i tin t b u sec. ahr t uly e g l sa i o paeu esht scr ad p rpi e o e gn h f ecfl sta i eue n apo r t t b i ite n s a n h si l ai tw n t haw a te fete so lha op a P t ns ato er hthyel y h u er t. e h d , te w n t hate tffb s tn i t ohr ai t te hy ato erh s a uyed g o te pt ns hy n e , w n t haa i o “ h ta men ta te rsib i ato er k d fs ”ht ashthi et e g n h r s n rsetdT e uso ao th wotn men ta tee epc .h q et n b u “o f ” ashthr e i e ma b gp ite q i ,b thr ia e oa y e asn h “u t u tees tmp rl e” caatro h q ato te u i revo metht hrc t te uly fh ad oy ni n n ta e i t r sp otrs u es u p r et l s. s fn 3
  5. 5. T O e teae i t o r T e ....hn e M o es vrh l n h h us h CAREC anl ff ra t g , mi i ttre ta rfl c a tn i sy i cag g d g s fi l hte et s n g k wt hn i nh a d s u n h n c u s n sakn lhe s r I rv e ce ta n h i l d ad prlgi td t s t oi s usht i t o i g a.p d g s frl p g n ta dyi ioe Fr e te s il s o s ei ad ht at s vr ut r h mui se e n me . h, c s at emoe et lT is re ii rd cd i a u st cv, r rs u h t fi l sn o ue wt sne i f. s a d t h ad id t te ri wt a u reT e s cags n y l o h mon g i sni .h mui hn e es n h s c ad h s re cagsj t sh n h sy hn e. n te t fi l hn e, sa te i tk cags a d u g D r g h op as , o f w sh ae ao n n s t a e “ ui tih si ltyh wotn a te ra ru d yu ro q i a n h? o rom u t t i t” e g T p e h T e .... h n e M h lsmpo e l p t i t y h CAREC a n l e i rv s e a ng b : 1 Cet gap aeua dtr e vrn n. . rai ecflu i y n i me t n o o 2 Off r gaming ttredt ce h t at io e . ei n d i safi l o u ta d yi s vr h me a dt t frl p n isi o s e . ’ me e Pi t te em“ ep erai ” e gd ni d s r ro h tr s e d pi t n b i i t e a a o l v o n e fi cn arkNg t gld c rd et n s e te lmae li ls, i i a el e rsad l p h u i t ic i hn e a e t han aetNg t gl 16 ) ai tw o aeothi elg gn (i i a ,8 0. t ns h hv l te i hn e P e s r oi tt n o a ad i t r sb ct te i o b cmi r nai t dy n n h ae u j to h rk f eo n e o g e s g pyh t ( sc20) h cue f iub d l p a scoi J t,00. e as o d tre s e cn cui T s e b mayi l i n i ,us g cv i ,ai su e e n, c d g o en rn at ie vr u tb s nu n s i it s o ad ei s t ce t te ai tad i lb i ia n dv e at hd o h pt n,n s y e gn c a e mp n s ag stn (ga &O tk ,07 R sln s e t n e et g U rs z i 20) eu i l p r i en . tg e d pi t n hetn te elg rcsad xed h si l erai traesh han poes n etn s op a v o i t s y. ai tw o an tet r po e o ai ad l t t s P t ns h cn o rsae rn t fl g n a o o a e l n s cnui ad g ai .h CAREC anlmi i t o fs n n ai t nT e ....hn es d g o t o ’ nh s re h l te ad ad er o pt ns vrn h,l t fi l o sh hn s n hat f ai teey i ta a d d s e g l n h. it g Wa i Tme in i tg Q et n 1-7 rdrclrl e t seic xei cs u si s 01 ae i t e td o pc epr ne o e y a fi e ta ec i o e a i t ,eci d i ,n ,gi ht ahn l w in i pr v t adaa , vv t g me e e me n pt nspr pi o b i crd o. si frsiac ai t ec t n f e g ae fr k g o as tne e ’ e o n A n s ad ee i hliui a e pnno e w in t . n rcin e n s g b d a i l s a i i vg p n vv t g me A dte es o hleseso pt ns h ne sc n ,h sne f e l nsfr ai tw o ed uh ps e as tnes n eaebtd y xed d a i t . siac io l xcrae b etn e w in i s y t g me S ff r g cusn n epn e peet o t fna u ei ocria “xad d rsn, u o ler n ” i , u e crn l i lmemai eey n t ed sad vr ho o g at , k g vrmi e n l s n eey oc i n sne fxett n n u cr i y n erb .h “at es o epc i ad net n u b aal T e ps ao at e , peetad uue es t ei,c ai o lte rsn rsn,n ftr cae o x t r t g n h peet s” e n y mo n isff r g o uv eS cs N l n20,.8) met u ei t srv (ak & e o ,07p6 5 n n i s . S ff r gs raeotnin ia u sae mi ad o l u ei ipi t,f li n n nhrd n n su n v e vg d , ad a b cmfr d n b rasrnen h rsl i o n cn e o ot o l yesuac ite eo t n f e y uo te or s n cnen. h w re ad o crs i e akd b u o g i pi o t , d h sne ht n n oa Whn se ao t n o g a cnrl n te es ta “vrti p sie a d n”o ep h pt n eeyh g os lw s o e t ke te ai t n b e e e me n cmfr b ,h epr ne cusn eci d i .u ei o ot l te xei c ocripr v t S ff r g ae e ad a i etn si fr eo d l k i .i mi ts n w in xed t abyn c c t F e n e tg me o me v u t a ai t a ieet v mi tso h n r . cat o pt n i d rn fie n e t te us A hoi e s ff u e c evo mete ue te bi o pt nso o e i te ni n n rd csh ai y f ai tt cp wt hi r l t e h r piad l cnr ue t l re hlesesEey a a n a o o tb tsoe nd e l ns.vrpi n s i a ps n me i t n a d rt n fff cvnsad rmp pno d ai hs uai o e et ees n aa u i c o o i t e et eesT eeoeee w e pt ns r o ff cvns. hrfr,vn hn ai tae n i e f ie n c o r e slamis rd a me i t nte epr nes b u e-d n t e pi d ai ,hi xei c iao t “o l g ititk” n “o l g itil t h w o wlh ae ad h w o wlh a . n l s n l s s” T eeoete o o te ni n n adts esrad hrfr,h rl fh evo met n i t sos n e r sr cmfr ,l s ctarlitiepr ne o ot p y a ri l en h xei c. s a ic o s e T h CAREC anl s o -rga t i h pt n c h e T e ....hn e M in npo rmmaiwt te ai t b i alt w t i t n t ;hr ae e hrbo t e g b o ac t ayi tee r ni e asl e n e h a me t u b g n g n r n i sA ia ad nw eee yu ne ei i s o ed g. sn gre, hnvro etr nn n , yu ne T e o tn lrrirb s wt oe 8 h us f o etr h cnetbayso ut i vr 0 o ro . i , h n nrpti h hd fi io oinlo tn shd l fr o - eiv i -e n i r i cnetce u d o e te g tn g a e te ai to xei c i fl ai y vr 1-a cc . h pt n t epr net u vr toe a 0dy yl e e s l e e Fr e muiad auemaey i sblmoi ad u ut r s n ntr i grwt u t h, c h e t n n fli o d e in ,n ae ai twto to fs g rrs ai te d i egg pt ns i u cnui o f t t g hm. tg e h n ur n , r h f R te te eggmet i te sb atuntr ah r hi n ae n wt h mot eui laue i grad o ti muid t c te f mfcs g n maey n soh g s ir t hm r oui o l n c sa s o n y o te o n i o ot hs p si d t co s ae en n hi w d cmfr T ee oiv ir t n hv b e r s . te s a i i ni d s n ff cv men o ehni te ai t o n d t e a a e et e as fn ac g h pt n’ w e fi i n e s cp g cai ( l c Pr ,95 o i mehn m Me a & er 17) n s z y . 4
  6. 6. T e uso o te C H S uvy b u w ehr ai t h q et n n h H A P sr ao t hte pt ns i e e pr i ta “ e tffd eeyh g hy o lt cnrl ec v htt s ee h a i vrti te cu o o t d n d o te pi ite epso epr ni pr pi s hi a ”sh d eet fxei t lec t n. r n e a e o “vrti te cu ” o sabyn “ ht a ne e ” r Eeyh g hy o l g e fr eo d w a w s ed d o n d “ q i d”B yn te hs apiite o -hs a r u e . eo d h p yi la sh n np yi l e r c n c epr ne fu ei ta cn e hr e d ae n r xei c o sff r g hta ni e b me i td o e n t c n sn i s r l et i oe .S ff r gs d t co ta in t i cy orl e g rd u ei ia ii t n ht o d et cr a d n t te mo n o tp o pi b tahr d et rl e t a o h a u t rye f a ,u rte i i cye td o n sr l a pr i d x tni tra,o neti yad o h sd es ec v eiet l ett u cr n ,n t te ans ee s a h at o aotuueS cs N l n20,.7) f l ftr (ak & e o ,07p65 s s . “ ui tih si ltyh wotn ite op as ff o D r g h op as , o f d h h si lt d n s t a e d t a eeyh g hy o lt hlyu i yu p i ” vrti te cu o e o wt o r a ? n d p h n T p h n n g me t y T e .... h n e M h ls i p ima a e n b h CAREC a n l e wt a c aig p aeua dtr a d i ae v o me th t r t a ecflu i y n v u ln i n n ta e n o s r h lseee u eig y e rlv sff r b : p i n 1 Dsrcigp t nsrm ter i o ot . i at ai tf h ids mfr. t n e o c 2 Makn cniu u su d a du wa tdn i whc . sig o t o s o n s n n ne os i n e h cn e g aig n cn o rmi te ai t’w a b a i t a d a cmpo s h p t nso n t n e e cp g ca i . o i meh ns n ms T e esn h isff r g a atb td ai ad h pr w osu ei hs ti e men g n o n ru n po n s t w a ihp ei t h o hrht ngt e rg oi o ht apn g o i r e ta i eai s s n m s v ad straei a i w r ,n u ko n t s et n mothetn g t s os ad nn w a i b s n t t t . T iiw ee tffmut v psw a icn ay p rpi e h s hrs s a smoe at ht li l apo r t s ic l a t ad ht ne e . n , iw ee elg n cr g r o d w a i ed d A dis hr han ad ui ae s t i n q i d eetwt crt e d i ad ei cn a u e i rn, i uai me in n met g li l t ff h v ce n ic s n ad b i ncsay u n tu i tT e ni n n t drs e g eesrb t o sffic n. h evo met a n e r o cr muteee u ei o,th l s n t osntI fae srlv sff r g r tee t o w r i t i n a a, e . mut rv e p otn i fra frsuac, ree spoi o p r ie o cl o asrnef rlf d u ts m, o i, ad o rs u esMimin hr ud t co srd c g n fret l s. n z g amflir t n, ui fn i i sa i e n c t rn d arysek g l r ad o c e t ao l t ad i r ,pai c al n cni l o lw ue s a n e y sy l pt nso o rhn w a ihp ei ae at fh ai tt cmpeed ht apn g r pro te e s n h si ltffd i “vrti te cu ”o o t lai t op as t a o g eeyh g hy o l t cnr pt ns n n d o e ’ pi a. n Dsh re n R cvr i ag a d eoey c T e e in q et n o te C H S uvyo k th h rma i uso s n h H A P sr l a te ng i e o epc t n ad n es n i o te cn io u o xet i s n u d r ad g fhi o d i p n ao t n r tn d cag ad h cn d ne ai thv wt cni i i hre n te o fi ec pt ns ae i o t u g s e h nn te rcvra h meQ i otnd cag is es l i hi eoey t o . u e f ,i hrest sf , t r t e s r uw h l t n t d et n b i d n e hr a uro ia a mi e i co s e g o e i e i h r r s u r i n t n y n pr i d uh o e pt ns u o te ro . s ut n ec v rs t gt ai to t fhi o msI t co s ee e r nr i frh fmi ad o fi ec ite o n aai t flw o tea l n cn d nen hi w cpcyo oo y r t l me i ln n rn rcmmedt n ss i te d aad us g eo c i n ai si wt hi o t h r u d r ad g f ht hp ei , hto xetad o n es n i o w a i apn gw a t epc n h w t n s n , t maae ne i hre . o ng o c d cagd s o y ni n n i s esd ni n n; od soe s r s r r An i evo met a t se evo metw rsp kn t te ai thto ee i bb lcmi f mo td o h pt n ta cmpt wt ab o n r us e e h e go i te o mo ite us e or os r otn e hr o h ro r h o td crd rae f ni e n t n i i e t u d r o d rcuae rcldB t te d si ad n es o o acrtl eae . oh h ami o n t y l sn d cag o a ai t r p i s fri l fr t nl i hre f pt n ae o to ctai omai a s e n ic n o ecag. a evo metht h slt fl xhn eI n ni n n ta i ote o u n r s i l cmpees ntees nnrae rk f sn es n i o rhni ,hr ia i esd i o mi d r ad g o c s u t n ad o fs n n cnui . o “ ui tih si ltyd d cosn r s r te D r g h op as , i otr us o ohr n s t a d , e h si ltff ak i yu bu w ehr o w u h v te op as tlwt o a o t hte yu o l a e h t a h d hlyu edd hn o l th h si l e o nee w e yue te op a? p f t ” T p h c n T e .... h n e M h ls i dsh re l nn b : h CAREC a n l e wt i ag pa ig y 1 Po iiga a dtr b cdo ta isp ot e f . rvdn n u i y ak rp h ts u p ri o o v fcsdi e ig oue ltnn . s 2 Off r gte p otnt t cniu te o tig . ei h o p ru i o o t e h sohn n y n a dtr a d i ae p r ne t o . u i y n v u lx ei c a h me o s e T T e ....hn e M poi s n u i rbcdo ta i h CAREC anl rv e a ad oy akrp ht d t s b t fmi rrmue ui te op as yad u p rv oh a l f i o s d r g h h si lt ,n sp ot e a n t a i o fcsdiei . ahrhn un g h tl io o t foue ltn gR te ta tri te e v i ff o s n n esn T s nl e n o te tytri i o h CAREC anl i at ed fh s ,un gt T e ....hn e M g h a n t poi s cr g o t u yht xed te o cr rv e a ai cni i ta etn sh cnen d n nt 5
  7. 7. ad o as n o te ai t n fmi r h tru h n cmpsi frh pt n ad a l i tho g o e yg e f d cag. h CAREa H meM sr s ff rD Dso i hre T e ....t o T ei o es V ’ r s pr nls ta bi sh n wfmi r xei c o es aue ht r g te o a l epr ne f o n i a e rs u esno h h me eoey ni n n. et l si te o rcvrevo met fn t r R frne eeecs C nl i s oc s n uo JscM. 00. o sIUpyh s "el ei? r C r N r , ut, ( 0) e " i 2 D C scoi ray x tCi ae us s l s t e 2( ,83;u 3-9 03 2- q i 82 . ) 7 z T e ni n n o cr ite ai t xei c.h h evo met faesh pt n epr neT e r e e evo met sls nnevni ; ib t te w a” n ni n n ie ia i r t nis oh h “ htad r t f t e o t “ hr” f ht apn t te A di eo sw o ii w ee o w a hp eso hm. n , b cme “ h ”nt t s rpeett n fh i et n o te aei r T eeoe ersnai o ten ni s fh crg es hrfr, o t o v . eey ea o te hs aevo met re wt te vrd ti fh p yi lni n n megs i h l c r h s h pt n s a t b i eaal N r T e rt r a o es ai to so en prb . us hoi Mat R gr e s e e s td l r ta te ai t n te ni n n ae n t e c al hth pt n ad h evo met r o e a e y e r (o es21) ni n naPyh l i K n eh ri R gr 02. vo metlsco g t ent Ca , E r os k l k a Pr nE vo met o gunec i n ta te o s t es -ni n n C n rec,lmi hth o o r a g h hrh pt n au yte r te ni n n ie i e te ai t ci,h moe h evo met sl g e t r t f cnrlb hv r o ,n cpcyCa ,00. n , o t s eai , dad aai (ri 20) d o o mo t k A fi ayihr ai Si c mo e Ja Wasn ttshth nl, eC r g c ne d l en t s e ta te ln n e , o a o p r n i fr cr gt nfr t nl met p ot ie o a ai ,r s mai amo n u ts n a o o b t en ai t n crg e ocr a evo met ew e pt n ad aei r cu i n ni n n e v n r frh p yi ln si ule ta rseth ma o te hs aad p i asl htepc u n c r t f s d n yWasn21) i i ( t ,02. gt o K lrSWio , O(d . 9 3 T e i hiH p tei eet , l nE E .( 9) h Bo i yoh s . l s )1 . pl a s Wah go , C Iad rs. si tnD : l Pes n sn T tn s t T e ....hn e M cn io sh v uln ad oy h CAREC anl o d i te i aad u i r evo meto ev a a spr nl vlfai ad ni n n t sr s mot es al eo cr g n r e o e n cmfr I o s eo d a me i t n o eee h o ot t e byn pi d ai t rlv te .g n c o i sff r g fi s cmmo t te op azd ai t u ei o t n me o o n o h h si le pt n. ti e n r e P t ns k men g fhi xei c tru h hthy ai tmae ai o te epr ne ho g w a te e se n w a te ha Fo mak g irco s f o e e ad hthy er rm si d t t n o n i s . n sa i s cmmo t te op at poin acst ntr frh o n o h h si l rv i ceso aueo te t o dg ohr i cn nd ai tsp ot g et l siteo g tews o fi e pt n,u p rn rs u esn h l e e i fn n ad f no e n h h usad ersni te us w e n ot l l i t o r n rpeet g h n r hn e ny g , n e T h o ses o ite o m.h CAREC anl cn e rh in t h ro T e ....hn e M a n b cme h vtacrg e ite n h us fah op a eo te iulaei r h may o ro ec h si l r v n t dyB cl n sff r g n ehni teo grem a. y a g u ei ad n ac g h l e tr mi n n n T i pr pi o cr gT e ....hn e M cnr ue t a ec t n fai ,h CAREC anl o tb tso e o n moe oiv pt n epr ne hta i at C H S r p si ai t xei c ta cnmpcH A P te e e sr y crs uv soe. e Ca , ent H , reRcad . l , rc (d . 00. ri K n eh .Pi , i r H, s BueE .( 0) k c h Wa h )2 Pr nE vo met sco g: e Drco s n es -ni n n Pyh l y N w i t n ad o r o ei Pr et e. h a, J Lw ec El u A sc ts es cvsMaw hN . a rne r am soi e. p i : b a Me akR, Pr ,. 95 S lrg l i o pi te s o l c, . er C ( 7) e- u t n f a :h ue f z & y 1 . fe a o n a h- e bc ad yn t t in frh cnrlfho ipi l af d ak n hp oi r n g o te o t o crn a . p e cai o c n Ep erl 63 424 9 x N uo 4 ( ,5-6 . , ) Ng t gl F rne( 6 ) oe o N rn : a is n Wht i i a ,l ec. 8 0. ts n us gWht iad a i hn e o 1 N i t t in tF sA ra E io e .N wY r: . s o (it mei n d i d . e okD r c tn ) A p tn C . plo & o e Ng t gl F rne( 6 ) oe o H si l Junlf na i i a ,l ec. 8 4. ts n op a :o rao Metl hn e o 1 N ts Si c,05) 0-1.o 1. 9 /j 1. . 3 c ne1( , 3 6d i 0 12 p 0 1 0. e 14 4 : 1 b . 54 S csJL &N l nJP( 0) te ro n n hs a ak,.. e o ,.. 07 A h oy f o p yi l , s 2 . c sff r g n t sih si pt nsQ aH a h e,7 ) u ei ad r t op e ai t ul el R s1( , n u n c e . t 5 656 9d i 0 17 0 93369 54 7-8 .o 1. 7/ 4 7202 82. : 1 1 U rsG A, O tk ,. . 07 P t n pr pi o ga, . . z i SD ( 0) ai t ec t n f & en 2 . e e o evo metln n rn fc rcnr ui t s e ni n naad us g at s o tb t g o l p r i o i n e d tracsn nuoug ai es e ae n .o ou Ep d iubne ia ersri l tni cr u iTh k J x Me , s c n v t 223 2 938d i S. T G /e 22 9 [i 1( ,9 - .o JT S A Et m/ . 9 p] ) 0 : J j 12 i . R gr M. 02Jn ay 621) Si c oU i rH ma o es ( 1,aur2 ,02. c ne f n ay u n , 2 " e t B i s N rn T e r sa o ai t n rn te r s n e g. us g h oi : cmpn n o us g h oi ad n " i e o i e mo e 21, o d l 03f m s r cr nn rn . m/us gte r/ i r_u nb i s t . ur tus g o n rn _h oy n ayh ma_e g. ml e i c i ut n h A o th A to: b u te uh r S sn . zr h . ako l gd s p ne i ua EMae P . i cn we e a a i er , Ds d o n te s o muia evo metlei ,h ite rs et h ue f s s ni n nad s nsesh Pei n c r g d ad E o H an H a h ae ytms h h rd cs n C O f elg el C rS s i t e w i po ue c T n t T e A E hn e M. hr okn el cr,h h C R C anl I e w riha h aese hs uh rd n fci td d ct nl a i fr uss n a atoe ad ai ae e uai at in o n r ad l t o rn g e p yias n iw l u lhdn h fi lo te ff c o hs i ads e p bse ite e fh e et f cn l i d s n i o pt nsS e a b rahd t o e n ai t h cn e ece a s e . s zr elg el . m mae@han ha h o i tc H an H a h ae ytmsI . elg el C rS s , c i t e n 70 mi r g Di ,u e 0 0 S t i e reS i 12 hd v t R n , eaa 90 803809 eoN vd 8 52 0- -79 4 w whan ha h o w . lg el . m ei tc T T e ....hn e M ia rd mak h CAREC anl s t e r a o H an H a h ae ytmsI . f elg el C rS s , c i t e n ©21 H an H a h ae ytmsn. 03 elg el C rS s i t e I c Alg trsr d li seev . rh e 6
  8. 8. C E T 18 03809 -0 -4 -7 9 if@h an h a hcm no el g el . i t o w wh an h a haecm w .el g el cr. i t o L e sn i uo k H

×