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p
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Patien
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SERVQU
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CC B
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C
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An
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An
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Nu
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Po
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9
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1.
I
NT
RO
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Patien
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f
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th
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ca
lib
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f
m
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d
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f
ac
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wh
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is
n
o
t
f
o
u
n
d
in
o
t
h
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s
u
r
v
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s
[
1
]
.
T
h
e
c
o
n
ce
p
t
o
f
p
atien
t
s
ati
s
f
ac
tio
n
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eg
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in
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th
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s
tan
d
ar
d
o
f
tr
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tm
en
t
is
cr
u
cial
[
2
]
,
[
3
]
.
T
h
e
f
ac
to
r
s
th
at
af
f
ec
t
p
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s
atis
f
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a
n
ce
p
atien
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ac
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an
d
ex
p
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[
4
]
.
T
h
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ab
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to
f
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s
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s
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p
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f
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tiv
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an
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[
5
]
.
W
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ev
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at
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p
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p
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n
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ay
b
e
h
elp
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T
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m
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ca
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s
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v
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n
d
p
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atis
f
ac
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n
[
6
]
.
Du
e
to
th
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s
u
b
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o
f
p
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s
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in
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s
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b
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f
o
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d
in
a
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b
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s
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[
7
]
.
Per
s
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ex
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s
a
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d
ass
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en
ts
o
f
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v
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q
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if
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tly
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as
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id
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as
a
u
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iq
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p
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p
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tiv
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[
5
]
.
T
h
e
f
ac
to
r
s
t
h
at
in
f
lu
en
ce
p
atien
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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Sci
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2252
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8
8
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6
S
a
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fa
ctio
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w
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h
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s
ervices rece
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b
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p
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r
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(
A
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ti A
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1405
s
atis
f
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av
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b
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s
u
b
j
ec
t o
f
s
ev
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s
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s
tem
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r
ev
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[
8
]
.
C
o
m
p
ar
ab
ly
,
t
h
er
e
ar
e
s
till
f
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r
ev
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lo
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esear
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a
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d
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o
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f
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d
in
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d
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ex
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in
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o
f
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liter
atu
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e.
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cr
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f
o
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ass
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h
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s
an
d
in
f
lu
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b
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[
9
]
.
Sig
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ican
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ad
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ta
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k
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to
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f
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f
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r
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alp
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ac
tice
lawsu
its
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p
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[
1
0
]
.
R
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n
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s
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q
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in
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m
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r
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[
1
1
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.
Nu
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t
h
e
s
ig
n
if
ican
ce
o
f
s
o
cio
ec
o
n
o
m
ic
an
d
p
atien
t
-
r
elate
d
f
ac
to
r
s
in
d
eter
m
in
in
g
h
o
w
s
atis
f
ied
p
atien
ts
ar
e
with
th
eir
h
ea
lth
ca
r
e
s
er
v
ices
[
1
2
]
,
[
1
3
]
.
A
g
e,
s
ex
,
o
cc
u
p
atio
n
,
jo
b
p
o
s
itio
n
,
in
co
m
e,
an
d
ed
u
ca
tio
n
ar
e
s
o
c
io
d
em
o
g
r
ap
h
ic
f
ac
to
r
s
th
at
af
f
ec
t
th
e
s
atis
f
ac
tio
n
o
f
p
atien
ts
with
th
eir
h
ea
lt
h
ca
r
e
[
1
4
]
.
L
o
n
g
-
ter
m
u
n
e
m
p
lo
y
m
e
n
t
s
ig
n
if
ican
tly
c
o
r
r
elate
s
with
p
atien
t
s
atis
f
ac
tio
n
,
wh
er
ea
s
s
h
o
r
t
-
ter
m
u
n
em
p
lo
y
m
e
n
t,
b
ased
o
n
g
e
n
d
er
,
h
as a
s
m
aller
co
r
r
elatio
n
.
Pre
v
io
u
s
r
esear
ch
s
tated
th
at
SERVQUAL
d
im
en
s
io
n
s
,
e
x
ce
p
t
f
o
r
tan
g
ib
le
an
d
ass
u
r
an
ce
,
wer
e
s
ig
n
if
ican
tly
r
elate
d
to
p
atien
t
d
is
s
atis
f
ac
tio
n
af
ter
c
o
n
tr
o
llin
g
f
o
r
h
o
s
p
ital
v
a
r
iab
l
es,
with
r
eliab
ilit
y
,
r
esp
o
n
s
iv
en
ess
,
ass
u
r
an
ce
,
a
n
d
em
p
ath
y
b
ei
n
g
t
h
e
m
o
s
t
s
ig
n
if
ican
t
[
1
5
]
.
Patien
t
s
atis
f
ac
tio
n
ac
ts
as
a
m
e
d
iato
r
b
etwe
en
p
atien
t
lo
y
alty
an
d
t
h
e
q
u
ality
o
f
ca
r
e
p
r
o
v
id
e
d
b
y
m
ed
ical
s
taf
f
[
1
6
]
.
R
ea
s
o
n
s
w
h
y
we
ar
e
tak
in
g
th
is
r
esear
ch
in
clu
d
e
th
e
n
ee
d
to
u
n
d
er
s
tan
d
t
h
e
f
ac
to
r
s
th
at
co
n
tr
ib
u
te
to
p
atien
t
d
is
s
atis
f
ac
tio
n
in
r
eg
io
n
al
h
o
s
p
itals
an
d
th
e
im
p
o
r
tan
ce
o
f
im
p
r
o
v
in
g
p
atien
t
lo
y
alty
th
r
o
u
g
h
q
u
ality
ca
r
e.
Ad
d
itio
n
ally
,
ex
p
lo
r
i
n
g
th
e
r
elatio
n
s
h
ip
b
etwe
en
SERVQUAL
d
im
en
s
io
n
s
an
d
p
atien
t
s
atis
f
ac
tio
n
ca
n
p
r
o
v
id
e
v
alu
ab
le
in
s
ig
h
ts
f
o
r
en
h
an
cin
g
h
ea
lth
ca
r
e
s
er
v
ices in
r
eg
io
n
al
s
ettin
g
s
.
T
h
is
s
tu
d
y
aim
ed
t
o
ass
ess
p
atien
t
s
atis
f
ac
tio
n
with
h
o
s
p
ital
h
ea
lth
s
er
v
ices
b
y
u
s
in
g
a
q
u
esti
o
n
n
air
e
ad
m
in
is
ter
ed
to
ex
is
tin
g
p
atie
n
ts
.
T
h
e
n
o
v
elty
o
f
th
is
s
tu
d
y
lies
in
its
d
ir
ec
t
f
o
cu
s
o
n
p
ati
en
t
s
atis
f
ac
tio
n
with
h
ea
lth
s
er
v
ices,
wh
ich
p
r
o
v
i
d
es
d
ee
p
er
in
s
ig
h
ts
.
T
h
u
s
,
we
h
o
p
e
th
at
th
e
r
esu
lts
o
f
th
is
s
tu
d
y
ca
n
b
e
u
s
ed
to
im
p
r
o
v
e
a
n
d
e
n
h
an
ce
h
ea
lth
s
er
v
ices.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
is
a
q
u
an
titativ
e
s
t
u
d
y
with
a
c
r
o
s
s
-
s
ec
tio
n
al
d
esig
n
.
T
h
is
s
tu
d
y
was
co
n
d
u
cte
d
at
o
n
e
o
f
th
e
r
eg
i
o
n
al
h
o
s
p
itals
in
B
im
a
C
ity
,
NT
B
,
I
n
d
o
n
esia.
Ou
tp
atien
ts
wh
o
r
ec
ei
v
ed
m
ed
ical
tr
ea
tm
en
t
b
etwe
en
J
an
u
ar
y
an
d
J
u
n
e
2
0
2
4
wer
e
elig
ib
le
to
b
e
in
clu
d
ed
in
th
e
s
am
p
le.
T
h
is
s
tu
d
y
d
id
n
o
t
in
clu
d
e
p
atien
ts
wh
o
wer
e
u
n
d
er
1
8
y
ea
r
s
o
f
ag
e
o
r
m
en
tally
u
n
s
tab
le
b
ec
au
s
e
th
ey
co
u
ld
n
o
t
p
r
o
v
id
e
in
f
o
r
m
ed
co
n
s
en
t.
T
h
e
s
am
p
le
in
th
is
s
tu
d
y
was
4
3
7
p
atien
ts
,
ca
lcu
lated
u
s
in
g
th
e
Slo
v
in
f
o
r
m
u
la
ca
lcu
latio
n
,
f
r
o
m
4
7
,
9
6
3
p
atien
ts
wh
o
v
is
ited
f
r
o
m
J
an
u
ar
y
to
J
u
n
e
2
0
2
4
.
T
h
e
s
am
p
le
ca
lcu
latio
n
was
ca
r
r
ied
o
u
t
u
s
in
g
a
9
5
%
c
o
n
f
id
e
n
ce
in
ter
v
al
an
d
a
5
%
m
ar
g
i
n
o
f
e
r
r
o
r
.
W
e
ad
d
ed
1
0
%
o
f
th
e
n
u
m
b
er
o
f
s
am
p
les
o
b
tain
e
d
ac
c
o
r
d
in
g
to
t
h
e
Slo
v
in
f
o
r
m
u
la
,
s
o
t
h
at
th
e
n
u
m
b
er
o
f
s
am
p
les
o
b
tain
ed
was
(
3
9
7
(
w
ith
th
e
f
o
r
m
u
la)
+
4
0
(
1
0
%)
=
4
3
7
)
.
Sam
p
lin
g
was
ca
r
r
ied
o
u
t
u
s
in
g
th
e
clu
s
ter
m
eth
o
d
b
y
d
iv
i
d
in
g
th
e
s
am
p
le
ar
ea
in
to
5
r
eg
io
n
s
,
with
th
e
n
u
m
b
er
o
f
s
am
p
les
tak
en
f
r
o
m
ea
ch
r
e
g
io
n
th
at
h
ad
b
ee
n
tr
ea
te
d
at
B
im
a
R
eg
io
n
al
Ho
s
p
ital,
NT
B
,
I
n
d
o
n
esia
as
m
an
y
as
8
7
s
am
p
les.
E
ac
h
r
e
g
io
n
is
s
p
r
ea
d
o
u
t
b
y
5
r
esear
ch
team
m
e
m
b
er
s
wh
o
th
e
n
co
n
d
u
ct
a
s
u
r
v
ey
at
th
e
s
m
allest
lev
el,
n
am
ely
th
e
s
u
b
-
d
is
tr
ict.
I
n
o
r
d
er
f
o
r
th
e
s
am
p
le
t
o
r
e
p
r
esen
t
all
p
o
p
u
latio
n
ar
ea
s
,
we
d
o
n
o
t
e
x
clu
d
e
s
am
p
les in
th
e
s
m
alles
t a
r
ea
s
.
At
th
e
s
u
b
-
d
is
tr
ict
lev
el,
we
lo
o
k
f
o
r
s
am
p
les at
th
e
h
o
u
s
eh
o
l
d
lev
el.
W
e
d
o
th
is
in
ea
ch
r
eg
i
o
n
,
b
y
g
r
o
u
p
in
g
s
a
m
p
les in
th
e
lar
g
est ar
ea
to
s
a
m
p
les in
th
e
s
m
allest ar
ea
.
s
o
th
at
it will r
ep
r
esen
t
th
e
lar
g
est p
o
p
u
latio
n
.
R
esear
ch
in
s
tr
u
m
en
t
was
a
s
e
l
f
-
ad
m
in
is
ter
ed
q
u
esti
o
n
n
air
e
c
r
ea
ted
b
ased
o
n
a
liter
atu
r
e
r
e
v
iew.
T
h
e
q
u
esti
o
n
n
air
e
in
clu
d
e
d
1
9
s
atis
f
ac
tio
n
item
s
o
n
a
f
o
u
r
-
p
o
i
n
t
L
ik
er
t
s
ca
le
an
d
s
o
cio
d
em
o
g
r
ap
h
ic
q
u
esti
o
n
s
.
T
h
e
C
r
o
n
b
ac
h
'
s
alp
h
a
f
o
r
th
e
q
u
esti
o
n
n
air
e
was
0
.
9
5
.
I
n
th
i
s
s
tu
d
y
,
s
atis
f
ac
tio
n
in
d
ices
w
er
e
m
er
g
ed
in
to
t
h
e
SERVQU
AL
d
im
en
s
io
n
s
.
T
h
e
co
r
r
esp
o
n
d
in
g
9
5
%
co
n
f
id
e
n
ce
in
ter
v
als
(
C
I
)
an
d
ad
j
u
s
ted
o
d
d
s
r
atio
s
(
AOR)
wer
e
ca
lcu
lated
.
Data
was
o
b
tain
ed
u
s
in
g
a
q
u
esti
o
n
n
air
e
a
n
d
SERVQUAL
in
s
tr
u
m
en
ts
.
SP
SS
v
er
s
io
n
2
1
an
d
Mic
r
o
s
o
f
t
E
x
ce
l
s
p
r
ea
d
s
h
ee
ts
wer
e
u
s
ed
to
an
aly
ze
t
h
e
d
at
a.
Usi
n
g
th
e
m
ea
n
s
co
r
e
as
t
h
e
cu
to
f
f
p
o
in
t,
th
e
to
tal
s
co
r
e
o
f
all
1
9
item
s
was
s
p
lit
in
to
s
atis
f
ied
an
d
u
n
s
atis
f
ied
ca
teg
o
r
ies,
with
v
alu
es
eq
u
al
to
o
r
ab
o
v
e
th
e
m
ea
n
class
if
ied
as e
ith
er
.
T
h
e
C
hi
-
s
q
u
ar
e
test
an
d
lo
g
is
tic
r
e
g
r
ess
io
n
an
aly
s
is
wer
e
u
s
ed
.
T
h
is
r
esear
ch
eth
ics
p
ass
ed
th
e
eth
ical
r
ev
iew
o
f
th
e
in
s
titu
tio
n
o
f
Po
ltek
k
es
Kem
en
k
e
s
Ma
tar
am
,
NT
B
,
I
n
d
o
n
esia,
with
t
h
e
n
u
m
b
er
E
C
/3
5
/0
5
/2
0
2
4
/Po
ltek
k
es
Kem
en
k
es
Ma
tar
am
.
All
r
esear
ch
p
r
o
ce
d
u
r
es
wer
e
ap
p
r
o
v
ed
b
y
th
e
ap
p
lic
ab
le
p
r
in
ci
p
les
o
f
r
esear
ch
et
h
ics.
T
h
is
s
tu
d
y
also
o
b
tai
n
e
d
ap
p
r
o
v
al
f
r
o
m
th
e
r
esear
ch
s
u
b
jects
b
ef
o
r
e
b
ein
g
ca
r
r
ied
o
u
t.
All
th
e
d
ata
o
b
tain
ed
will
g
u
ar
an
tee
co
n
f
id
e
n
tiality
in
ac
co
r
d
an
c
e
with
th
e
ap
p
licab
le
p
r
o
v
is
io
n
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
4
0
4
-
1
4
1
1
1406
3.
RE
SU
L
T
S
T
ab
l
e
1
s
h
o
ws
th
a
t
th
e
m
ajo
r
i
ty
o
f
r
esp
o
n
d
en
t
s
w
er
e
ag
ed
b
et
wee
n
2
0
-
2
9
,
n
am
e
ly
1
0
2
r
e
s
p
o
n
d
en
t
s
(
2
3
.
3
4
%),
em
p
lo
y
ed
3
1
9
r
e
s
p
o
n
d
en
t
s
(
7
3
%),
an
d
h
ad
a
s
en
io
r
h
ig
h
s
ch
o
o
l
ed
u
ca
t
io
n
,
1
4
8
r
e
s
p
o
n
d
en
t
s
(
3
2
,
2
7
%).
B
a
s
ed
o
n
T
ab
le
2
,
p
at
ien
t
s
a
ti
s
f
ac
tio
n
i
s
clo
s
e
ly
r
e
la
ted
to
ag
e
,
em
p
lo
y
m
e
n
t
s
ta
tu
s
,
lev
e
l
o
f
ed
u
ca
t
io
n
,
an
d
p
r
o
v
id
er
f
r
ien
d
lin
e
s
s
,
w
i
th
p
-
v
alu
es
o
f
0
.
0
0
9
,
0
.
0
2
1
,
0
.
0
1
0
,
an
d
0
.
0
2
8
,
r
e
s
p
e
ct
iv
e
ly
.
I
t
i
s
a
l
s
o
k
n
o
wn
th
a
t
3
0
9
p
at
ien
t
s
(
7
0
.
7
%)
o
f
th
e
to
ta
l
s
a
m
p
l
e
wer
e
s
at
i
s
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h
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s
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2
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)
.
T
ab
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1
.
Dem
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as
s
h
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T
a
b
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3
,
w
ith
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r
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s
p
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s
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e
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an
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Pa
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ag
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2
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2
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t
o
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ia
b
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m
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s
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s
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af
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ed
p
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s
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,
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t
h
e
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h
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t o
p
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h
e
p
r
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d
er
-
f
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en
d
ly
d
im
en
s
i
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n
s
ar
e
al
s
o
r
e
la
ted
to
p
a
t
ien
t
s
a
ti
s
f
ac
tio
n
.
B
a
s
ed
o
n
T
ab
l
e
4
,
r
el
iab
il
i
ty
h
ad
th
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h
ig
h
e
s
t
m
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n
s
co
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m
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(
3
.
8
8
)
.
an
d
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p
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i
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s
s
d
im
en
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w
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s
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lo
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t
(
3
.
7
8
)
.
T
h
i
s
f
in
d
in
g
d
em
o
n
s
tr
ate
s
th
at
im
p
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v
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m
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s
a
t
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f
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n
i
f
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an
t
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b
y
th
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d
e
g
r
ee
o
f
s
er
v
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e
r
el
iab
il
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ty
.
R
e
s
p
o
n
s
iv
en
es
s
i
s
an
asp
ec
t
th
a
t n
e
ed
s
to
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p
r
o
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m
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r
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s
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s
f
y
in
g
s
er
v
i
ce
s
f
o
r
cu
s
to
m
er
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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Lo
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7
8
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
2
5
2
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0
6
I
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t J Pu
b
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Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
4
0
4
-
1
4
1
1
1408
4.
DIS
CU
SS
I
O
N
I
n
s
u
m
m
a
r
y
,
th
is
s
tu
d
y
aim
e
d
to
i
n
v
esti
g
ate
p
atien
t
s
atis
f
ac
tio
n
with
h
ea
lth
s
er
v
ices
at
a
h
o
s
p
ital.
Patien
t
s
atis
f
ac
tio
n
is
clo
s
ely
r
elate
d
to
ag
e,
em
p
lo
y
m
e
n
t
s
tatu
s
,
lev
el
o
f
ed
u
ca
tio
n
,
an
d
p
r
o
v
id
er
f
r
ien
d
lin
ess
,
with
p
-
v
alu
es
o
f
0
.
0
0
9
,
0
.
0
2
1
,
0
.
0
1
0
,
an
d
0
.
0
2
8
,
r
esp
ec
tiv
e
ly
.
I
t
is
also
k
n
o
wn
th
at
3
0
9
p
atien
ts
(
7
0
.
7
%)
o
f
th
e
to
tal
s
am
p
le
wer
e
s
ati
s
f
ied
with
th
e
h
ea
lth
s
er
v
ices
p
r
o
v
id
ed
.
T
h
e
n
u
m
b
er
o
f
d
is
s
atis
f
ie
d
p
atien
ts
was
1
2
8
(
ap
p
r
o
x
im
ately
2
9
.
3
%).
Nu
m
er
o
u
s
s
tu
d
ies
h
av
e
d
em
o
n
s
tr
ated
th
at
f
ac
to
r
s
s
u
ch
as
ag
e
[
1
7
]
,
g
en
d
e
r
[
1
8
]
,
ed
u
ca
tio
n
lev
el
[
1
9
]
,
an
d
em
p
lo
y
m
en
t
s
tatu
s
[
2
0
]
af
f
ec
t
h
o
w
well
p
atien
ts
ar
e
ass
ess
ed
f
o
r
th
e
h
ea
lth
s
er
v
ices
th
ey
r
ec
eiv
e.
T
h
is
is
in
lin
e
with
th
e
f
in
d
in
g
t
h
at
ag
e,
em
p
lo
y
m
e
n
t
s
tatu
s
,
an
d
ed
u
ca
tio
n
al
lev
el
wer
e
s
ig
n
if
ican
tly
r
elate
d
to
p
atien
t
s
atis
f
ac
tio
n
.
Dif
f
er
en
t
s
p
ec
ialties
/d
is
cip
lin
e
s
m
ay
af
f
ec
t
p
atien
t
s
atis
f
ac
tio
n
with
h
ea
lth
s
er
v
ices r
ec
eiv
ed
.
T
h
is
s
tu
d
y
ass
es
s
ed
th
e
co
r
r
el
atio
n
s
b
etwe
en
ex
p
lan
ato
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y
f
a
cto
r
s
an
d
th
e
f
iv
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d
im
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n
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io
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o
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er
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ice
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ac
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n
an
d
o
v
er
all
s
er
v
ice
s
atis
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ac
tio
n
.
T
h
e
r
esu
lts
s
h
o
wed
th
at
p
atien
ts
o
f
th
is
ag
e
h
ad
a
p
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itiv
e
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elatio
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s
h
ip
with
th
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d
im
en
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io
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s
o
f
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eliab
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y
,
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esp
o
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s
iv
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ess
,
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d
tan
g
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le,
ass
u
r
an
ce
,
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d
em
p
ath
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(p
=
0
.
0
1
5
,
0
.
0
0
7
,
0
.
0
1
1
,
0
.
0
0
4
,
an
d
0
.
0
1
2
,
r
esp
ec
tiv
ely
)
.
T
h
e
h
ig
h
est ch
an
ce
o
f
r
eliab
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y
an
d
r
esp
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o
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in
p
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ag
ed
2
0
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y
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r
s
,
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d
C
I
v
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lu
es
o
f
1
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9
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(
1
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9
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n
d
1
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7
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(
1
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0
3
–
2
.
0
9
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o
f
r
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tiv
ely
.
Fo
r
th
e
tan
g
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les
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im
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,
th
e
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ig
h
est
ch
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c
e
was
in
th
o
s
e
ag
ed
4
0
-
4
9
wit
h
OR
an
d
C
I
v
alu
es
o
f
1
.
9
8
(
2
.
0
3
–
4
.
3
7
)
.
W
h
en
p
air
ed
with
ed
u
ca
tio
n
,
th
is
d
em
o
n
s
tr
ates
p
atien
ts
'
m
atu
r
ity
an
d
h
o
w
th
ey
e
v
alu
ate
th
e
d
eliv
er
y
o
f
h
ea
lth
ca
r
e
s
er
v
ices
[
2
1
]
.
T
h
e
lik
elih
o
o
d
th
at
an
eld
er
ly
p
atien
t
wo
u
ld
h
av
e
s
ig
n
if
ican
t
ex
p
er
ien
ce
with
h
ea
lth
ca
r
e
f
a
cilities
in
cr
ea
s
es
with
ag
e,
wh
ich
af
f
ec
ts
b
o
th
th
e
f
ac
ilit
y
s
e
lectio
n
p
r
o
ce
s
s
an
d
th
e
ev
alu
atio
n
o
f
s
er
v
ices
r
en
d
er
ed
[
2
2
]
.
T
h
e
av
ailab
ilit
y
o
f
tan
g
ib
le
o
b
jects,
s
p
o
tles
s
eq
u
ip
m
en
t,
an
d
well
-
ap
p
o
in
ted
f
ac
ilit
ies s
ig
n
if
ican
tly
r
aises
p
atien
ts
'
o
p
in
io
n
s
o
n
th
e
q
u
ality
o
f
ca
r
e
th
e
y
r
ec
eiv
e
[
2
3
]
.
I
n
e
m
p
l
o
y
m
en
t
s
tatu
s
,
all
d
i
m
en
s
io
n
s
also
in
f
lu
e
n
ce
p
ati
en
t
s
atis
f
ac
tio
n
with
p
-
v
al
u
e
s
f
o
r
ea
ch
d
im
en
s
io
n
,
n
am
ely
0
.
0
2
5
(
r
e
liab
ilit
y
)
,
0
.
0
1
7
(
r
esp
o
n
s
iv
en
ess
)
,
0
.
0
2
0
(
tan
g
i
b
les),
0
.
0
0
2
(
ass
u
r
an
ce
)
,
0
.
0
1
8
(
em
p
ath
y
)
,
an
d
t
h
e
OR
v
alu
e
(
C
I
)
,
r
esp
ec
tiv
ely
.
th
e
h
ig
h
e
s
t
f
o
r
r
esp
ec
tiv
e
em
p
lo
y
ed
s
tatu
s
,
n
am
ely
0
.
9
6
(
0
.
7
7
–
1
.
2
1
)
,
0
.
8
9
(
0
.
6
7
–
1
.
1
8
)
,
0
.
7
6
(
0
.
4
1
–
1
.
4
0
)
,
0
.
7
9
(
0
.
5
1
–
1
.
7
0
)
,
0
.
9
2
(
0
.
7
2
–
1
.
2
3
)
.
T
h
ese
r
esu
lts
s
u
g
g
es
t
th
at
em
p
lo
y
m
en
t
s
tatu
s
p
la
y
s
a
s
ig
n
if
ican
t
r
o
le
i
n
in
f
l
u
en
cin
g
p
atien
t
s
atis
f
ac
tio
n
a
cr
o
s
s
th
e
v
a
r
io
u
s
d
im
en
s
io
n
s
o
f
h
ea
lth
ca
r
e
s
er
v
ices.
T
h
e
o
d
d
s
r
atio
s
in
d
icate
d
th
e
p
o
ten
tial
im
p
ac
t
o
f
em
p
lo
y
m
en
t
o
n
o
v
er
all
p
atien
t
s
atis
f
ac
tio
n
lev
els.
Ov
er
all,
th
ese
f
in
d
i
n
g
s
h
ig
h
lig
h
t
th
e
im
p
o
r
tan
ce
o
f
c
o
n
s
id
er
in
g
em
p
lo
y
m
en
t
s
tatu
s
wh
en
ass
ess
in
g
an
d
im
p
r
o
v
in
g
p
atien
t satis
f
ac
tio
n
in
h
ea
lth
c
ar
e
s
ettin
g
s
.
I
n
lev
el
o
f
ed
u
ca
tio
n
,
r
esp
o
n
d
en
ts
with
u
n
iv
e
r
s
ity
ed
u
ca
tio
n
s
tatu
s
h
ad
t
h
e
h
i
g
h
est
p
r
o
b
ab
ilit
y
v
alu
e
in
all
d
im
en
s
io
n
s
,
with
OR
an
d
C
I
v
alu
es
o
f
0
.
8
4
(
0
.
5
8
–
1
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3
4
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,
1
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4
2
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7
8
–
2
.
5
1
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,
0
.
5
1
(
0
.
1
9
–
1
.
5
6
)
,
0
.
5
9
(
0
.
2
2
–
1
.
6
7
)
,
1
.
4
5
(
0
.
8
2
–
2
.
8
7
)
an
d
p
-
v
alu
es
o
f
0
.
0
1
1
(
r
eliab
ilit
y
)
,
0
.
0
9
(
r
esp
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n
s
iv
en
ess
)
,
0
.
0
1
7
(
t
an
g
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les),
0
.
0
0
7
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ce
)
,
a
n
d
0
.
0
2
2
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m
p
at
h
y
)
.
B
ec
au
s
e
th
ey
h
av
e
a
n
o
p
e
n
m
en
tality
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u
ca
ted
p
atien
ts
ty
p
ically
f
ee
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p
en
to
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ec
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in
g
h
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lth
ca
r
e.
T
h
is
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s
a
r
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f
th
eir
in
cr
ea
s
ed
a
war
en
ess
o
f
s
o
cial
h
ea
lth
is
s
u
es
an
d
th
eir
b
r
o
ad
er
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
h
ea
lth
s
er
v
ices
o
f
f
er
ed
to
th
em
[
2
4
]
.
Acc
o
r
d
i
n
g
to
o
u
r
r
esea
r
ch
,
e
d
u
ca
tio
n
was
p
o
s
itiv
ely
co
r
r
elate
d
.
I
t
h
as
b
ee
n
d
e
m
o
n
s
tr
ated
t
h
at
liter
a
cy
af
f
ec
ts
h
o
w
h
ea
lth
ca
r
e
is
ev
alu
ated
b
ec
au
s
e
in
f
o
r
m
e
d
p
eo
p
le
b
ase
th
eir
d
e
cisi
o
n
s
o
n
k
n
o
wled
g
e,
p
r
o
ce
d
u
r
es,
ex
p
er
ie
n
ce
s
,
an
d
p
r
o
ce
s
s
es
[
2
5
]
.
Similar
to
th
e
p
r
o
v
id
er
f
r
ien
d
lin
ess
v
ar
iab
le,
all
d
im
e
n
s
io
n
s
ar
e
also
r
elate
d
to
p
atien
t
s
atis
f
ac
tio
n
with
p
-
v
alu
es
o
f
0
.
0
2
3
(
r
eliab
ilit
y
)
,
0
.
0
2
8
(
r
esp
o
n
s
iv
en
ess
)
,
0
.
0
2
5
(
ta
n
g
ib
les),
0
.
0
0
2
(
ass
u
r
an
ce
)
,
a
n
d
0
.
0
2
6
(
em
p
ath
y
)
.
Hig
h
er
s
atis
f
ac
tio
n
is
a
r
e
s
u
lt
o
f
th
e
h
ea
lth
ca
r
e
f
ac
ilit
y
's
p
r
o
f
ess
io
n
al
s
er
v
ices
a
n
d
th
e
f
r
ien
d
lin
ess
o
f
th
e
s
er
v
ice
p
r
o
v
id
er
.
Hea
lt
h
s
er
v
ice
m
an
ag
e
r
s
n
ee
d
to
co
n
s
id
er
th
ese
v
ar
iab
les
b
ec
a
u
s
e
th
ey
ar
e
ad
ju
s
tab
le
y
et
s
ig
n
if
ican
t
elem
en
ts
th
at
d
eter
m
in
e
th
e
q
u
ality
o
f
ca
r
e
.
A
p
o
s
itiv
e
r
ep
u
tatio
n
o
f
th
e
s
er
v
ice
p
r
o
v
id
e
r
en
co
u
r
a
g
es
cu
s
to
m
er
s
to
r
etu
r
n
,
wh
ich
in
cr
ea
s
es
th
eir
u
s
ag
e
an
d
ac
ce
s
s
ib
ilit
y
[
2
6
]
.
I
f
c
lien
ts
ar
e
g
iv
en
th
e
o
p
p
o
r
tu
n
ity
t
o
talk
o
p
en
l
y
a
b
o
u
t
th
eir
illn
ess
an
d
th
e
ca
r
e
th
ey
r
eq
u
ir
e
,
th
eir
s
atis
f
ac
tio
n
will
r
is
e
[
2
7
]
.
Acc
o
r
d
in
g
t
o
s
ev
er
al
au
t
h
o
r
s
,
a
welc
o
m
in
g
e
n
v
ir
o
n
m
en
t
a
m
o
n
g
s
taf
f
m
em
b
er
s
a
n
d
clin
ician
s
in
h
ea
lth
ca
r
e
in
s
titu
tio
n
s
b
o
o
s
ts
em
p
lo
y
ee
t
r
u
s
t,
p
atien
t
r
eten
tio
n
r
ates,
a
n
d
th
e
a
b
ilit
y
o
f
p
r
o
f
ess
io
n
als
to
s
ec
u
r
ely
h
a
n
d
le
p
atien
ts
’
p
r
iv
ate
i
n
f
o
r
m
atio
n
[
2
8
]
.
Ov
er
all,
s
er
v
ice
s
atis
f
ac
tio
n
was
p
o
s
itiv
ely
c
o
r
r
elate
d
with
th
e
ea
s
e
o
f
r
ec
eiv
in
g
ca
r
e.
T
h
e
f
ac
ilit
y
'
s
lo
ca
tio
n
an
d
ac
ce
s
s
ib
ilit
y
to
h
ea
lth
ca
r
e
s
er
v
ices
af
f
ec
t
h
o
w
ea
s
y
it
is
to
r
ec
eiv
e
ca
r
e
[
2
9
]
.
C
u
s
to
m
er
s
atis
f
ac
ti
o
n
is
s
ig
n
if
ican
tly
af
f
ec
ted
b
y
h
av
i
n
g
d
ir
ec
t
ac
ce
s
s
to
s
er
v
ice
p
r
o
v
id
er
s
a
n
d
ch
o
o
s
in
g
a
f
ac
ilit
y
th
at
b
est
m
atch
es
th
e
p
atien
t'
s
n
ee
d
s
[
3
0
]
.
T
h
is
ca
n
b
e
f
u
r
th
er
ex
p
lain
ed
b
y
th
e
f
ac
t
th
a
t
ev
en
in
ca
s
es
wh
en
a
p
atien
t'
s
co
n
d
itio
n
is
n
o
t
p
a
r
ticu
lar
ly
g
o
o
d
,
ca
r
e
ca
n
b
e
r
ec
ei
v
ed
m
o
r
e
q
u
ick
ly
f
o
r
th
o
s
e
wh
o
liv
e
clo
s
e
to
m
e
d
ical
f
ac
ilit
ies.
R
esear
ch
er
s
an
d
p
r
ac
titi
o
n
er
s
ca
n
g
ain
i
n
s
ig
h
ts
in
to
th
e
d
im
en
s
io
n
s
o
f
s
er
v
ice
q
u
ality
a
n
d
p
atien
t
h
ap
p
in
ess
co
v
er
ed
in
th
is
s
tu
d
y
,
wh
ich
ca
n
h
elp
im
p
r
o
v
e
th
ese
m
etr
ics.
Sin
ce
th
ese
s
er
v
ice
d
im
en
s
io
n
s
ar
e
en
tire
ly
in
d
e
p
en
d
e
n
t
o
f
o
n
e
an
o
th
er
,
p
atien
ts
s
h
o
u
l
d
r
ec
e
iv
e
p
r
o
m
p
t
s
er
v
ice
f
r
o
m
th
ei
r
s
er
v
ice
p
r
o
v
i
d
er
s
r
eg
ar
d
less
o
f
th
eir
ag
e
,
em
p
lo
y
m
en
t
s
tatu
s
,
ed
u
ca
tio
n
le
v
el,
o
r
f
r
ie
n
d
lin
ess
[
3
1
]
.
T
h
ese
d
im
en
s
io
n
s
ar
e
s
ig
n
if
ican
t
in
d
icato
r
s
o
f
s
er
v
i
ce
s
.
I
t
is
im
p
er
ativ
e
t
h
at
s
er
v
i
ce
p
r
o
v
id
er
s
p
r
io
r
itize
th
e
r
esp
o
n
s
iv
en
ess
o
f
th
eir
o
f
f
er
in
g
s
at
an
elev
ated
lev
el.
d
eliv
er
y
as
th
e
p
atien
t
r
ec
eiv
es
th
e
s
er
v
ice
wh
ile
it
i
s
b
ein
g
p
r
o
v
id
ed
b
y
th
e
s
er
v
ice
p
r
o
v
id
e
r
.
Ma
in
tain
in
g
p
atien
ts
is
ju
s
t
as
v
ita
l
a
s
g
iv
in
g
th
em
q
u
ality
m
ed
i
ca
l
ca
r
e
[
3
2
]
.
T
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
S
a
tis
fa
ctio
n
w
ith
h
ea
lth
s
ervices rece
ived
b
y
p
a
tien
ts
in
r
eg
i
o
n
a
l
…
(
A
n
ih
a
r
ya
ti A
n
i
h
a
r
ya
t
i
)
1409
en
v
ir
o
n
m
en
t
i
n
wh
ich
s
er
v
ice
s
ar
e
r
e
n
d
er
ed
,
am
e
n
ities
,
ar
e
a
ac
ce
s
s
,
r
elev
an
t
s
tan
d
ar
d
p
r
o
ce
s
s
es,
ae
s
th
etics,
an
d
atm
o
s
p
h
e
r
e
all
co
n
tr
i
b
u
te
to
a
p
atien
t'
s
f
ee
lin
g
o
f
s
ec
u
r
it
y
an
d
c
o
m
f
o
r
t w
ith
in
th
e
f
ac
ili
ty
[
3
3
]
.
Patien
ts
r
ec
eiv
e
th
e
s
er
v
ice
wh
en
t
h
e
s
er
v
ice
p
r
o
v
id
er
is
p
r
o
v
id
in
g
it,
wh
ich
is
a
n
ess
en
tial
co
m
p
o
n
en
t
o
f
th
e
d
eliv
er
y
o
f
h
ea
lth
s
er
v
ices.
I
t
is
b
eliev
e
d
an
d
ex
p
ec
te
d
th
at
t
h
e
p
atie
n
t
will
r
ec
eiv
e
th
e
s
er
v
ice
[
3
4
]
,
a
n
d
an
y
th
in
g
t
h
a
t
f
alls
s
h
o
r
t
o
f
ex
p
ec
tatio
n
s
will
lead
to
d
is
co
n
ten
t,
wh
ich
is
r
ep
r
esen
ted
b
y
th
e
v
ar
ian
ce
in
th
e
s
atis
f
ac
tio
n
r
at
e.
Patien
ts
m
ay
f
in
d
it
ch
allen
g
in
g
to
r
ec
eiv
e
th
e
s
am
e
o
r
a
co
m
p
ar
ab
le
s
er
v
ice
o
n
a
f
o
llo
w
-
u
p
v
is
it
b
ec
au
s
e
o
f
th
e
v
ar
iety
o
f
s
er
v
ices
o
f
f
er
e
d
in
h
ea
lth
ca
r
e
f
ac
ilit
ies
ac
r
o
s
s
th
e
n
atio
n
o
r
e
v
en
with
in
th
e
s
am
e
f
ac
ilit
y
[
3
5
]
.
T
h
is
lead
s
to
v
ar
iatio
n
s
in
p
ati
en
t
s
atis
f
ac
tio
n
with
th
e
s
er
v
ices.
T
h
is
is
b
ec
au
s
e
o
f
th
e
p
o
s
s
ib
ilit
y
th
at
p
atien
t
s
wo
u
ld
n
ee
d
to
s
ee
s
ev
er
al
d
o
cto
r
s
o
r
h
o
s
p
ital
d
e
p
ar
tm
en
ts
.
Fo
r
e
x
am
p
le,
p
er
s
o
n
n
el
in
p
h
ar
m
ac
ies,
lab
o
r
ato
r
ies,
an
d
em
e
r
g
en
c
y
r
o
o
m
s
m
ay
n
o
t
p
r
o
v
id
e
co
n
s
is
te
n
t
ca
r
e
o
v
er
v
is
its
.
Owin
g
to
th
e
in
tan
g
ib
le
n
atu
r
e
o
f
s
er
v
ice
d
eliv
er
y
,
it
is
esp
ec
ially
cr
u
cial
to
a
d
d
r
ess
ca
r
e
o
u
tco
m
es,
d
eliv
e
r
y
,
an
d
ac
ce
s
s
.
As
a
r
esu
lt,
it
is
t
h
e
d
u
t
y
o
f
th
e
s
er
v
ice
p
r
o
v
id
er
to
p
r
o
v
id
e
s
er
v
ices
t
h
at
g
o
ab
o
v
e
an
d
b
e
y
o
n
d
wh
at
p
atien
ts
ex
p
ec
t,
an
d
to
m
in
im
ize
o
r
co
m
p
letely
r
em
o
v
e
p
er
ce
iv
ed
r
is
k
[
3
6
]
.
O
u
r
f
i
n
d
i
n
g
s
,
w
h
i
c
h
w
e
p
r
e
s
en
t
e
d
u
s
i
n
g
t
h
e
c
h
i
-
s
q
u
a
r
e
t
es
t
,
i
n
d
i
c
a
t
e
d
t
h
at
a
l
l
s
t
u
d
y
o
u
t
c
o
m
e
f
a
c
t
o
r
s
w
e
r
e
p
o
s
it
i
v
e
l
y
c
o
r
r
e
la
t
e
d
wi
t
h
h
e
a
l
t
h
s
y
s
t
e
m
-
r
el
a
t
e
d
p
a
r
a
m
ete
r
s
a
s
w
e
ll
as
c
e
r
t
ai
n
d
e
m
o
g
r
a
p
h
i
c
c
h
a
r
a
c
t
e
r
is
ti
c
s
.
R
e
g
a
r
d
l
es
s
o
f
t
h
e
h
o
s
p
it
a
l
o
r
n
a
t
i
o
n
,
o
t
h
e
r
s
t
u
d
i
es
h
a
v
e
d
e
m
o
n
s
t
r
a
t
e
d
t
h
a
t
t
h
e
r
e
is
a
c
o
n
s
is
t
en
t
l
y
h
i
g
h
d
e
g
r
e
e
o
f
u
n
h
a
p
p
i
n
e
s
s
w
it
h
w
a
i
ti
n
g
t
i
m
e
s
[
3
7
]
.
A
c
c
e
s
s
t
o
c
a
r
e
is
p
o
s
it
i
v
e
l
y
c
o
r
r
e
l
a
te
d
w
i
t
h
r
e
li
a
b
i
li
ty
o
u
t
c
o
m
e
s
,
w
h
i
c
h
i
n
c
l
u
d
e
ti
m
e
s
p
e
n
t
o
n
t
e
s
t
s
an
d
r
e
s
u
l
t
c
o
l
l
ec
t
i
o
n
,
w
a
i
ti
n
g
f
o
r
a
c
a
ll
,
wa
i
t
i
n
g
f
o
r
a
c
o
n
s
u
l
t
a
t
i
o
n
,
a
n
d
o
t
h
e
r
i
n
d
i
c
a
t
o
r
s
[
3
8
]
.
T
h
e
h
e
a
l
t
h
c
a
r
e
f
a
c
i
l
i
t
y
’
s
a
p
p
r
o
a
c
h
a
b
l
e
s
t
a
f
f
b
o
o
s
t
s
p
a
ti
e
n
t
r
e
t
e
n
ti
o
n
r
a
t
e
s
.
Ad
d
i
t
i
o
n
a
l
l
y
,
p
a
t
i
e
n
t
s
f
e
e
l
m
o
r
e
s
e
c
u
r
e
i
n
t
h
e
i
r
a
b
ili
t
y
t
o
h
a
n
d
l
e
p
e
r
s
o
n
a
l
a
n
d
c
o
n
f
i
d
e
n
t
i
a
l
i
n
f
o
r
m
a
t
i
o
n
a
n
d
h
av
e
a
s
o
li
d
c
l
i
n
i
c
a
l
e
x
p
e
r
i
e
n
c
e
.
P
o
s
i
ti
v
e
c
o
r
r
e
l
a
ti
o
n
s
w
e
r
e
o
b
s
e
r
v
e
d
b
e
t
w
e
e
n
t
h
e
f
r
i
e
n
d
l
i
n
e
s
s
o
f
t
h
e
s
e
r
v
i
c
e
p
r
o
v
i
d
e
r
a
n
d
p
a
t
i
e
n
t
s
a
t
is
f
a
ct
i
o
n
.
I
n
t
h
i
s
s
t
u
d
y
,
w
e
d
i
s
c
o
v
e
r
e
d
a
s
t
r
o
n
g
c
o
r
r
e
l
a
tio
n
b
e
t
w
e
e
n
p
at
i
e
n
t
s
at
is
f
a
c
t
i
o
n
a
n
d
c
o
n
t
e
n
t
.
T
h
is
s
t
u
d
y
i
d
e
n
ti
f
i
e
d
i
m
p
o
r
ta
n
t
d
em
o
g
r
a
p
h
i
c
a
n
d
h
e
a
l
t
h
s
y
s
t
e
m
v
a
r
i
a
b
l
es
li
n
k
e
d
t
o
o
v
e
r
a
ll
s
e
r
v
i
c
e
s
a
t
is
f
a
c
ti
o
n
,
t
a
n
g
i
b
l
e
s
,
r
e
s
p
o
n
s
i
v
e
n
e
s
s
,
a
n
d
d
e
p
e
n
d
a
b
i
l
i
t
y
o
f
s
e
r
v
i
c
es
.
H
o
we
v
e
r
,
m
o
r
e
c
o
m
p
r
e
h
e
n
s
i
v
e
s
a
t
is
f
a
c
t
i
o
n
c
r
i
t
e
r
ia
a
n
d
i
n
d
i
c
a
t
o
r
s
c
o
v
e
r
i
n
g
a
w
i
d
e
r
r
an
g
e
o
f
c
h
a
r
a
c
t
e
r
i
s
t
i
cs
s
h
o
u
l
d
b
e
i
n
c
l
u
d
e
d
i
n
f
u
t
u
r
e
p
o
li
c
i
es
t
o
p
r
o
v
i
d
e
a
s
t
r
o
n
g
e
r
c
a
s
e
f
o
r
p
a
t
ie
n
t
s
at
is
f
a
c
ti
o
n
w
i
th
p
o
l
i
c
y
m
a
k
i
n
g
a
n
d
/
o
r
r
e
f
o
r
m
i
n
t
h
e
h
e
a
l
t
h
s
y
s
t
e
m
.
5.
CO
NCLU
SI
O
N
Ag
e,
wo
r
k
s
tatu
s
,
e
d
u
ca
tio
n
al
attain
m
en
t,
an
d
p
r
o
v
id
e
r
f
r
ie
n
d
lin
ess
all
h
a
v
e
a
n
im
p
ac
t
o
n
p
atien
t
s
atis
f
ac
tio
n
,
ac
co
r
d
in
g
to
th
e
s
tu
d
y
,
wh
ic
h
f
o
u
n
d
th
at
7
0
.
7
%
o
f
p
atien
ts
wer
e
s
atis
f
ied
a
n
d
2
9
.
3
%
wer
e
n
o
t
with
th
eir
h
ea
lth
ca
r
e.
Patien
t
s
atis
f
ac
tio
n
is
s
tr
o
n
g
ly
af
f
ec
t
ed
b
y
ag
e,
wh
ich
is
r
elate
d
to
th
e
d
im
e
n
s
io
n
s
o
f
r
eliab
ilit
y
,
r
esp
o
n
s
iv
en
ess
,
an
d
tan
g
ib
le,
ass
u
r
an
ce
,
an
d
em
p
ath
y
.
Patien
ts
ag
ed
2
0
–
2
9
y
e
ar
s
h
av
e
th
e
h
ig
h
est
p
o
ten
tial
f
o
r
r
esp
o
n
s
iv
en
ess
a
n
d
d
ep
en
d
ab
ilit
y
,
a
n
d
p
atien
ts
ag
ed
4
0
–
4
9
y
ea
r
s
h
av
e
th
e
m
o
s
t
o
p
p
o
r
tu
n
ities
f
o
r
tan
g
ib
les.
E
d
u
ca
tio
n
al
attain
m
en
t
also
p
lay
s
a
s
ig
n
if
ican
t
r
o
le
in
p
atien
t
s
atis
f
ac
tio
n
,
with
h
ig
h
er
le
v
els
o
f
ed
u
ca
tio
n
o
f
ten
co
r
r
elatin
g
with
h
ig
h
er
s
atis
f
ac
tio
n
.
Pro
v
id
er
f
r
ien
d
lin
ess
is
an
o
th
er
k
ey
f
ac
to
r
th
at
ca
n
s
ig
n
if
ican
tly
in
f
lu
en
ce
a
p
atie
n
t'
s
o
v
er
all
ex
p
er
ien
ce
an
d
p
er
ce
p
tio
n
o
f
th
eir
h
ea
lth
ca
r
e.
Patien
t
s
ati
s
f
ac
tio
n
was
also
in
f
lu
en
ce
d
b
y
em
p
l
o
y
m
en
t
s
tatu
s
,
with
th
e
h
ig
h
est
p
r
o
b
ab
ilit
y
v
alu
e
ass
o
ciate
d
with
u
n
iv
er
s
ity
ed
u
ca
tio
n
.
Patien
t
s
atis
f
ac
tio
n
was
also
in
f
lu
e
n
ce
d
b
y
th
e
f
r
ien
d
lin
ess
o
f
th
e
p
r
o
v
id
er
.
Fu
r
th
er
m
o
r
e,
p
eo
p
le
wh
o
h
av
e
co
m
p
lete
d
m
o
r
e
ed
u
ca
tio
n
ty
p
ically
ex
p
r
ess
g
r
ea
ter
s
atis
f
ac
tio
n
with
th
eir
h
ea
lth
ca
r
e
en
co
u
n
ter
s
.
I
t
is
im
p
o
r
tan
t
f
o
r
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
to
c
o
n
s
id
er
th
ese
f
ac
to
r
s
wh
en
i
n
ter
ac
tin
g
with
p
atien
ts
to
en
s
u
r
e
p
o
s
itiv
e
ex
p
er
ien
ce
s
.
Ad
d
itio
n
ally
,
ad
d
r
ess
in
g
p
atien
t
co
n
ce
r
n
s
an
d
p
r
o
v
id
in
g
clea
r
c
o
m
m
u
n
icatio
n
ca
n
co
n
tr
ib
u
te
to
h
i
g
h
er
lev
els
o
f
s
atis
f
ac
tio
n
am
o
n
g
all
d
em
o
g
r
ap
h
ics.
T
h
e
r
e
c
o
m
m
e
n
d
a
t
i
o
n
i
s
f
o
r
h
e
a
l
t
h
c
a
r
e
p
r
o
v
i
d
e
r
s
t
o
t
a
i
l
o
r
t
h
e
i
r
a
p
p
r
o
a
c
h
b
a
s
e
d
o
n
t
h
e
s
p
e
ci
f
i
c
n
e
e
d
s
a
n
d
p
r
e
f
e
r
e
n
c
e
s
o
f
e
a
c
h
p
a
t
i
en
t
t
o
o
p
t
i
m
i
z
e
t
h
eir
o
v
e
r
a
l
l
s
a
ti
s
f
a
ct
i
o
n
w
i
t
h
t
h
e
c
ar
e
t
h
e
y
r
e
c
e
i
v
e
.
H
e
a
l
t
h
c
a
r
e
p
r
o
v
i
d
e
r
s
c
a
n
c
r
e
a
t
e
m
o
r
e
p
e
r
s
o
n
a
l
i
z
e
d
a
n
d
e
f
f
e
c
t
i
v
e
t
r
e
a
t
m
e
n
t
p
l
a
n
s
f
o
r
e
a
c
h
p
a
ti
e
n
t
b
y
c
o
n
s
i
d
e
r
i
n
g
f
a
c
t
o
r
s
s
u
c
h
as
a
g
e
,
e
d
u
c
a
t
i
o
n
l
e
v
e
l
,
a
n
d
i
n
d
i
v
i
d
u
a
l
c
o
n
c
e
r
n
s
.
RE
F
E
R
E
NC
E
S
[
1
]
D
.
C
.
F
e
r
r
e
i
r
a
,
I
.
V
i
e
i
r
a
,
M
.
I
.
P
e
d
r
o
,
P
.
C
a
l
d
a
s
,
a
n
d
M
.
V
a
r
e
l
a
,
“
P
a
t
i
e
n
t
s
a
t
i
sf
a
c
t
i
o
n
w
i
t
h
h
e
a
l
t
h
c
a
r
e
ser
v
i
c
e
s
a
n
d
t
h
e
t
e
c
h
n
i
q
u
e
s
u
se
d
f
o
r
i
t
s
a
ss
e
ssm
e
n
t
:
A
sy
s
t
e
m
a
t
i
c
l
i
t
e
r
a
t
u
r
e
r
e
v
i
e
w
a
n
d
a
b
i
b
l
i
o
me
t
r
i
c
a
n
a
l
y
s
i
s,
”
H
e
a
l
t
h
c
a
re
,
v
o
l
.
1
1
,
n
o
.
5
,
p
.
6
3
9
,
F
e
b
.
2
0
2
3
,
d
o
i
:
1
0
.
3
3
9
0
/
h
e
a
l
t
h
c
a
r
e
1
1
0
5
0
6
3
9
.
[
2
]
N
.
A
k
t
h
a
r
,
S
.
N
a
y
a
k
,
a
n
d
Y
.
P
a
i
P
,
“
D
e
t
e
r
m
i
n
a
n
t
s
o
f
p
a
t
i
e
n
t
sa
t
i
sf
a
c
t
i
o
n
i
n
A
s
i
a
:
E
v
i
d
e
n
c
e
f
r
o
m
sy
s
t
e
mat
i
c
r
e
v
i
e
w
o
f
l
i
t
e
r
a
t
u
r
e
,
”
C
l
i
n
i
c
a
l
Ep
i
d
e
m
i
o
l
o
g
y
a
n
d
G
l
o
b
a
l
H
e
a
l
t
h
,
v
o
l
.
2
3
,
p
.
1
0
1
3
9
3
,
S
e
p
.
2
0
2
3
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
c
e
g
h
.
2
0
2
3
.
1
0
1
3
9
3
.
[
3
]
Q
.
G
a
o
e
t
a
l
.
,
“
P
a
t
i
e
n
t
sa
t
i
sf
a
c
t
i
o
n
a
n
d
i
t
s
h
e
a
l
t
h
p
r
o
v
i
d
e
r
-
r
e
l
a
t
e
d
d
e
t
e
r
mi
n
a
n
t
s
i
n
p
r
i
m
a
r
y
h
e
a
l
t
h
f
a
c
i
l
i
t
i
e
s
i
n
r
u
r
a
l
C
h
i
n
a
,
”
B
MC
H
e
a
l
t
h
S
e
rv
i
c
e
s R
e
se
a
rc
h
,
v
o
l
.
2
2
,
n
o
.
1
,
p
.
9
4
6
,
D
e
c
.
2
0
2
2
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
9
1
3
-
0
2
2
-
0
8
3
4
9
-
9.
[
4
]
B
.
G
a
v
u
r
o
v
a
,
J.
D
v
o
r
s
k
y
,
a
n
d
B
.
P
o
p
e
s
k
o
,
“
P
a
t
i
e
n
t
s
a
t
i
sf
a
c
t
i
o
n
d
e
t
e
r
mi
n
a
n
t
s
o
f
i
n
p
a
t
i
e
n
t
h
e
a
l
t
h
c
a
r
e
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
En
v
i
r
o
n
m
e
n
t
a
l
R
e
se
a
rc
h
a
n
d
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
8
,
n
o
.
2
1
,
p
.
1
1
3
3
7
,
O
c
t
.
2
0
2
1
,
d
o
i
:
1
0
.
3
3
9
0
/
i
j
e
r
p
h
1
8
2
1
1
1
3
3
7
.
[
5
]
A
.
F
.
H
a
n
n
a
w
a
,
A
.
W
.
W
u
,
A
.
K
o
l
y
a
d
a
,
A
.
P
o
t
e
m
k
i
n
a
,
a
n
d
L
.
J
.
D
o
n
a
l
d
s
o
n
,
“
T
h
e
a
s
p
e
c
t
s
o
f
h
e
a
l
t
h
c
a
r
e
q
u
a
l
i
t
y
t
h
a
t
a
r
e
i
m
p
o
r
t
a
n
t
t
o
h
e
a
l
t
h
p
r
o
f
e
s
s
i
o
n
a
l
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1411
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Un
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a
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In
d
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with
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s
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rsity
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ly
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istratio
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q
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istratio
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c
a
n
b
e
c
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tac
t
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d
a
t
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m
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:
m
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n
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p
@g
m
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il
.
c
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m
.
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a
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Dire
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te
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ies
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istratio
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m
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h
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m
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p
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c
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re
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h
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s
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th
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re
d
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p
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v
iew
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ics
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ll
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a
c
ti
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rti
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ip
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tes
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re
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r
fo
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tab
le
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ter
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rn
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ls
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c
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s
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rsin
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h
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a
n
d
BM
C
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rsin
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,
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s
we
ll
a
s
a
n
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m
b
e
r
o
f
n
a
ti
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n
a
l
sc
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e
n
ti
fic
jo
u
rn
a
ls.
Cu
r
re
n
tl
y
,
he
h
o
l
d
s
a
m
a
n
a
g
e
rial
p
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siti
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t
th
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e
rsity
a
s
th
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Vic
e
Re
c
to
r
fo
r
Ac
a
d
e
m
ic
Affa
ir
s.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
sa
stra
wa
n
@g
m
a
il
.
c
o
m
.
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