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saswavlo programis umTavresi aspeqtebi

mtkicebulebebze damyarebuli medicina ( Evidence based Medicine) jandacvis profesionalebis swavlebis procesSi. saswavlo programis umTavresi aspeqtebi. mtkicebulebebze damyarebuli medicinisa ( Evidence Based Medicine ) da mtkicebulebebze damyarebuli jandacvis ( Evidence Based Care ) koncefcia;

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saswavlo programis umTavresi aspeqtebi

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  1. mtkicebulebebze damyarebuli medicina(Evidence based Medicine)jandacvis profesionalebis swavlebis procesSi

  2. saswavlo programis umTavresi aspeqtebi • mtkicebulebebze damyarebuli medicinisa (Evidence Based Medicine) da mtkicebulebebze damyarebuli jandacvis (Evidence Based Care) koncefcia; • mtkicebulebebze damyarebuli medicinis koncefciis praqtikaSi danergvis meTodebi; • mtkicebulebebze damyarebuli medicinisa da mtkicebulebebze damyarebuli samedicino momsaxurebis yoveldRiur klinikur praqtikaSi danergvis gzebi; • mtkicebulebebisa da informaciis kritikuli Sefasebis meTodebi; • mtkicebulebebis danergvis processa da, amasTan kavSirSi, organizaciebisa da gundebis dinamika; • gaidlainebis SemuSavebis process da multidisciplinarul garemoSi maTi ganxorcielebis principebi;

  3. mtkicebulebebze damyarebuli medicina, rogorc koncefcia Mmizani: efeqturi da Sedegiani samedicino daxmarebis miwodeba, jandacvis organizaciebis saqmianobaSi arsebuli xarvezebis minimumamde Sesamcireblad

  4. EBM axali klinikuri specialobaa, romelic saSualebas gvaZlevs gamoviyenoT klinikuri da jandacvis mecnieruli kvlevis Sedegebi pacientis sawolTan, ambulatoriebsa da saavadmyofoebSi da mTlianad mosaxleobaSi.

  5. mtkicebulebebze damyarebuli medicina • mtkicebulebebze damyarebuli medicinis mizania samecniero kvlevasa da klinikur praqtikas Soris napralis Semcireba; • igi ganisazRvreba, rogorc Tanamedrove samecniero kvlevis Sedegebis sistematuri Ziebis, Sefasebis da gamoyenebis procesi, rac klinikuri gadawyvetilebis miRebis safuZveli unda gaxdes.

  6. pacientze zrunvadiagnostireba prognozireba mkurnaloba sxva klinikuri da paraklinikuri sakiTxebi . . . ? safuZvlianobasaWiroebs dasabuTebas

  7. mecnieruli dasabuTebis procesi • 1. informaciis saWiroebis gardaqmna kiTxvebad, romlebsac SeiZleba gaeces pasuxi; • 2. am pasuxebisaTvis saukeTeso mecnieruli dadasturebis Zieba; • 3. mecnieruli kvlevis safuZvlianobisa (anu ramdenad axlosaa is simarTlesTan) da misi praqtikuli gamoyenebis SesaZleblobis kritikuli Sefaseba; • 4. aRniSnuli kritikuli Sefasebis Sedegebis gamoyeneba klinikur praqtikaSi; • 5. samuSaos Sesrulebis Sefaseba. .

  8. mtkicebaze dafuZnebuli medicinis mniSvneloba • mecnierulad dasabuTebulia jandacvis profesionalebis mier Catarebuli samedicino gamokvlevebisa da mkurnalobis mxolod 1/3-is saWiroeba; • mecnierulad dausabuTebelia samedicino gamokvlevebisa da mkurnalobis 1/3-is klinikuri saWiroeba da efeqtianoba, magram miuxedavad amisa, isini mainc tardeba. • samedicino gamokvlevebisa da mkurnalobis danarCen 1/3-s, miuxedavad imisa, rom maTi saWiroeba mecnierulad dasabuTebulia, klinikur praqtikaSi ar iyeneben.

  9. ra warmoadgens mtkicebas? • mtkice dasabuTeba minimum erTi sistematiuri mimoxilvidan, romelic ramodenime kargad organizebul randomizebul sakontrolo kvlevas moicavs; • mtkice dasabuTeba minimum erTi Sesabamisad struqturirebuli da Sesaferisi moculobis randomizebuli sakontrolo kvlevidan; • samecniero dasabuTeba ararandomizebuli kargad organizebuli da struqturirebuli kvlevidan, kohortuli, seriuli an SemTxveva kontrolis kvlevidan; • samecniero dasabuTeba kargad organizebuli araeqsperimentuli kvlevidan, romelic tardeba erTze meti samecniero centris an jgufis mier; • mecnierulad dasabuTebuli mkvlevar-avtoritetTa azrebi, aRwerilobiTi naSromebi an eqspertTa komitetebis angariSebi.

  10. mtkicebaze dafuZnebuli medicinidan mtkicebaze dafuZnebuli jandacvisakenkritikuli faqtorebi • ram SeiZleba Seuwyos xeli cvlilebas • problemis identifikacia • mtkicebulebebis Zieba • kritikuli Sefaseba • ekonomikuri Sefaseba • organizaciuli auditi • mtkicebulebaTa difuzia • ganxorcieleba (implementacia) • saqmianobis marTva • xarisxis uwyveti gaumjobeseba-cvlilebis ganmapirobebeli Sinagani faqtori

  11. ra ganapirobebs “`cvlilebas`” ZiriTadi elementebi: • politikuri • sakanonmdeblo • ekonomikuri • socialuri • teqnologiuri

  12. mtkicebulebaTa Zieba • The Cochrane Library on line (http://www.cochrane.org/) • b. NHS Economic Evaluation Database, University of York (http://www1.york.ac.uk/inst/crd/welcome.htm) • c. MEDLINE database of journal articles published by the U.S. National Library of Medicine, (http://www.nlm.nih.gov) • d. Bandolier - Newsletter of evidence-based health care from Oxford (www.jr2.ox.ac.uk/bandolier) • e. The Centre for Evidence Based Medicine is a site containing information, statistics, teaching materials and discussion of Evidence-Based Medicine. (http://www.cebm.utoronto.ca/) • f. Centre for Health Evidence: (http://www.cche.net/usersguides/main.asp) • g. Centre for Clinical Effectiveness (http://www.med.monash.edu.au/healthservices/cce/) that will actually search for you if given a clinical question. • h. Netting the evidence (http://www.shef.ac.uk/~scharr/ir/netting/) • i. University of California resource centre (http://medicine.ucsf.edu/resources/guidelines/users.html) • EBM journals such as the Evidence-Based Medicine published by the BMJ Publishing Group (http://ebm.bmjjournals.com/ )  

  13. zogierTi terminis ganmarteba • absolituri riski_drois gansazRvrul monakveTSi, individualurad specifikuri movlenis aRmocenebis albaToba • SedarebiTi riski_ramdenjer metia (SedarebiTi riski>1-ze) an naklebia (SedarebiTi riski<1-ze) erT jgufSi, meoresTan SedarebiT, raime movlenis aRmocenebis albaToba

  14. Kkritikuli Sefasebarogor gavceT pasuxi Semdeg SekiTxvebs: • ramdenad sarwmunoa kvlevis Sedegebi? • rogoria Sedegebi? • damexmareba Tu ara es Sedegebi pacientis samedicino momsaxurebis procesSi?

  15. kvlevis tipebi aRwerilobiTi • ekologiuri kvleva-moicavs mTels populacias • ganivi (erTmomentiani, prevalentobis kvleva)-fokusi individualebze analizuri • observaciuli • intervenciuli

  16. aRwerilobiTi kvlevebiekologiuri kvleva • dakvirvebis erTeuli: populacia • Seiswavlis avadobisa da saavadebianobis sxvadasxvaobas geografiuli areebisa da drois trendis mixedviT • gamousadegaria mizez-Sedegobrvi urTierTkavSiris dasadgenad

  17. aRwerilobiTi kvlevebiganivi (Cross-sectional) kvleva • dakvirvebis erTeuli: individi • aRwers daavadebis gavrcelebas pirovnebasTan (asaki, sqesi, rasa, ojaxuri mdgomareoba, samuSao, cxovrebis stili), adgilTan da drosTan mimarTebaSi; • tardeba swrafad da iolia • Sedegebi exmareba jandacvis mimwodeblebs resursebis efeqtian moxmarebasa da prevenciis efeqturi gegmis SemuSavebaSi • saSualebas iZleva Sefasdes individis mdgomareoba daavadebis arseboba ararsebobis da, aseve, im TvalsazrisiT ganicdis Tu ara individi kvlevis momentisaTvis raime zemoqmedebas. magram, ganivi kvleva ar iZleva saSualebas ganisazRvros uswrebda Tu ara win zemoqmedeba daavadebas.

  18. Ddiax ara analizuri kvlevebiobservaciuli:SemTxveva-kontrolis kvleva moicavs pacientebs (klinikur SemTxvevebs), romelTac aReniSnebaT Sesaswavli daavadeba an gamosavali, da sakontrolo pacientebs, romelTac es daavadeba an gamosavali ar aReniSnebaT. risk-faqtoris zemoqmedeba daavadeba amonarCevi Sesaswavli daavadebiT (SemTxveva) Ddiax populacia, romelic ganicdisrisk-faqtoris zemoqmedebas ara dro amonarCevi Sesaswavli daavadebis gareSe (kontroli) kvleva

  19. analizuri kvlevebiobservaciuli:SemTxveva-kontrolis kvleva Zlieri mxareebi: • ar aris Zviri da SesaZlebelia Sesruldes swrafad; • Sesaferisia im daavadebebis SefasebisaTvis, romelTac xangrZlivi latenturi periodi aqvT; • optimaluria iSviaTi daavadebebis evaluaciisaTvis; • iZleva saSualebas Seswavlil iqnas mravalferovani etiologiuri faqtorebi calkeuli daavadebisaTvis. kvlevis sisusteebi: • araefeqturia iSviaTi zemoqmedebis SeswavlisaTvis; • ar iZleva avadobis dadgenis saSualebas pirebSi, romlebic eqvemdebarebian an ar eqvemdebarebian zemoqmedebas; • SesaZloa rTuli iyos zemoqmedebasa da daavadebas Soris droebiTi urTierTkavSiris dadgena; • gaxsenebis Secdomasa (Recall bias) da SerCevis SecdomasTan (speqtris Secdoma) (Selection bias) dakavSirebuli problemebi.

  20. gaxsenebis Secdoma-sistemuri Secdoma, romelic gvxvdeba SemTxveva-kontrolis kvlevebSi. zemoqmedebis an movlenebis gaxsenebis unari gansxvavdeba SemTxvevebis da sakontrolo jgufebSi. SemTxvevebis jgufis pacientebs SeiZleba kiTxvebi ufro metjer da CaZiebiT dausvan, vidre sakontrolo jgufis pacientebs. savaraudoa, rom daavadebulma ukeT gaixsenos, hqonda Tu ara Sexeba ama Tu im zemoqmedebasTan, vidre janmrTelma. • SerCevis Secdoma-sistemuri Secdoma dakavSirebuli SerCevasTan. gamowveulia imiT, rom populaciis SerCeuli nimuSi ar aris reprezentatiuli (warmomadgenlobiTi) riskis qveS myofi mTliani populaciis mimarT. kvlevaSi ar aris CarTuli pacientebis Sesabamisi speqtri. Sedarebad jgufebs Soris arsebobs sistemuri gansxvavebebi (mag. daavadebis Sorswasuli formis mqone pacientebs adareben janmrTel pirebs).

  21. analizuri kvlevebiobservaciuli:kohortuli kvleva daavadeba ar aris risk-faqtoris zemoqmedeba daavadeba + risk-faqtoris zemoqmedeba icvleba - populacia amonarCevi dakvirvebis periodi + risk faqtoris zemoqmedebas adgili ara aqvs -

  22. Kkohortuli kvlevebi Zlieri mxareebi: • Rirebulia iSviaTi zemoqmedebebis Sesaswavlad; • SesaZlebelia calkeuli zemoqmedebis mravalgvari gamosavlebis Seswavla; • maTi saSualebiT SesaZloa dadgindes droebiTi urTierTkavSiri zemoqmedebasa da daavadebas Soris; • maTi saSualebiT SesaZlebelia Secdomis minimalizacia zemoqmedebis efeqtis dadgenisas; • SesaZlebelia avadobis gamoTvla. susti mxareebi: • arasakmarisad efeqturia iSviaTi daavadebebis SefasebisaTvis; • prospeqtuli:Zviria da did dros moiTxovs; • danakargebma mimdinareobis periodSi SesaZloa zegavlena iqonios Sedegebze.

  23. analizuri kvlevebiintervenciuli kvlevebi • arakontrolirebuli klinikuri cda, rodesac intervencia xorcieldeba pacientebis jgufSi sakontrolo jgufTan erTad da randomizaciis gareSe; • kontrolirebuli, magram ararandomizebuli klinikuri kvleva, rodesac arsebobs sakontrolo jgufi, magram kvlevis subieqtebis ganawileba intervenciisa da sakontrolo jgufebSi randomizebulad ar xdeba; • randomizebuli kontrolirebuli kvleva, rodesac subieqtebs randomizaciis principiT anawileben intervenciisa da sakontrolo jgufebSi.

  24. randomizebuli kontrolirebuli kvleva yvelaze Zlier kvlevebs miekuTvneba! ! ! dadebiTi mxareebi: • `damamaxinjebeli faqtorebis~ iseTi ganawileba, rac minimumamde amcirebs Secdomis albaTobas; • SesaZlebelia "brma" meTodis gamoyeneba; • randomizacia aiolebs statistikur analizs. nakli: • Zviria: moiTxovs did drosa da Tanxebs; • SesaZloa adgili hqondes "moxaliseTa Secdomas" (Volunteer bias) • drodadro Tavs iCens eTikuri problemebi.

  25. Kklinikuri kvlevis sarwmunoeba: Sinagani da garegani ganmsazRvrebi faqtorebi: ramdenad kargad aris SemuSavebuli kvlevis gegma; sworad Catarda Tu ara SerCeva da monacemebis analizi; ramdenad gamoxatulia sistematuri da SemTxveviTi Secdomebi. ?  sarwmunoeba=sargebloba

  26. garegani sarwmunoeba anu ganvrcobadoba (external validity, or generalizability)- eqimisaTvis es niSnavs pasuxs SekiTxvaze-`Tu mocemuli kvlevis Sedegebi marTebulia, maSin SemiZlia Tu ara maTi gamoyeneba Cemi pacientisaTvis?~

  27. ris safuZvelze SeiZleba miviRoT sarwmuno faqtebi?mecnierul mtkicebulebaTa (evidence) sarwmunoebis done • Ia done-randomizebuli sakontrolo kvlevebis meta-analizis safuZvelze miRebuli mecnieruli mtkicebebi; • Ib done-sul mcire, erTi randomizebuli kvlevis Sedegad miRebuli mtkicebebi; • IIa done- mtkicebebi miRebuli: sul mcire, erTi kargad organizebuli ararandomizebuli kontrolirebuli kvlevis safuZvelze • II b done-sul mcire, erTi sxva tipis kargad organizebuli eqsperimentuli kvlevis safuZvelze; • III done- mtkicebebi, miRebuli kargad organizebuli, araeqsperimentuli aRwerilobiTi kvlevebis, rogoricaa mag. SedarebiTi kvlevebi, korelaciuri kvlevebi da klinikuri SemTxvevebis Seswavla, safuZvelze; • IV done- eqspertis an eqspertTa jgufebis mosazreba da/an klinikuri gamocdileba.

  28. mecnierul faqtebze dayrdnobiT Camoyalibebuli rekomendaciis safuZvlianoba (a)rekomendaciis safuZvlianoba sarwmuno mecnieruli faqtebiT dasturdeba (b) rekomendaciis safuZvlianoba sakmaod sarwmuno mecnieruli faqtebiT dasturdeba (g) mecnieruli faqtebi naklebad sarwmunoa imisaTvis, rom rekomendacias daedos safuZvlad. rekomendaciis Camoyalibeba sxva faqtorebisa da mosazrebebis safuZvelze xdeba (d) mecnieruli faqtebi sakmaod naTlad adasturebs rekomendaciis usafuZvlobas (e) mecnieruli faqtebi savsebiT ewinaaRmdegeba rekomendacias

  29. Kkvlevis Sedegebis interpretacia

  30. absoluturi riskis Semcireba (ARR) (ARR)=(CER)-(EER) sakontrolo jgufSi movlenis sixSire - eqsperimentul jgufSi movlenis sixSire • SedarebiTi riskis Semcireba (RRR) (RRR)=(CER-EER)/CER*100 • pacientebis raodenoba, romelic mkurnalobas saWiroebs (NNT) NNT=1/ARR

  31. Sedegis gansazRvruloba • sarwmunoebis intervali: sarwmunoebis intervali (si) raodenobrivad gansazRvravs Sedegebis gazomvis sarwmunoebas. igi aRwers, Tu ramdenad misaRebia nimuSze (amonarCevze) miRebuli Sedegi zogadi populaciisaTvis • P-maCvenebeli aRwers albaTobas, Tu ramdenad SesaZlebelia, rom kvlevis Sedegebi SemTxveviTobiT iyos ganpirobebuli. p-maCvenebeli 0-dan 1-mde meryeobs. 0 miuTiTebs, rom Sedegebi ar SeiZleba SemTxveviTobiT iyos ganpirobebuli, xolo 1,0 miuTiTebs, rom Zalian maRalia SemTxveviTobis albaToba.

  32. kritikuli Sefasebis savarjiSo #1 miokardiumis infarqtisSemdgom periodSi angiotenzingardamqmneli fermentis inhibitorebis gamoyenebis Taobaze Catarebuli AIRE kvleva Sefasda, rogorc yvelaze mniSvnelovani, romelic mravali wlis manZilze Catarebula. kvlevaSi monawile 2006 pacienti, romlebsac gulis ukmarisobis klinikuri suraTi aReniSnebodaT randomizaciis principis safuZvelze gaanawiles ramiprilisa da placebos jgufebSi (ix. cxrili 1).

  33. cxrili 1ramiprili placebo • pacientebis raodenoba 1014 992 • sikvdili 170 222 • sikvdilis riski 0,168 (170/1014) 0,224 (222/992) gansazRvreT SedarebiTi riskis Semcireba absoluturi riskis Semcireba mkurnalobisTvis saWiro raodenoba

  34. kritikuli Sefasebis savarjiSo #1 RR=0,168/0,224=0,75 RRR=1-0,75=0,25 ARR=0,224-0,168 NNT=1/ARR=18

  35. Eekonomikuri Sefaseba • Cost minimisation-xarjis minimalizaciis analizi_identuri gamosavlebis mqone, magram gasxvavebuli resursebiT ganxorcielebuli ori programisaTvis gaweuli xarjebis Sedareba • resursebi gamoixateba monetaruli formiT • iTvleba, rom sargebeli/gamosavlebi identuria da maTi Sedareba ar xdeba • dadebiTi mxareebi: martivi da iafia gasagebad ioli • Nnakli gamosavlebis gaigiveba ararealuria

  36. Cost effectiveness-xarjT-efeqturobis analizi • xarjebi gamoxatulia monetaruli formiT • gamosavlebi izomeba fizikaluri erTeulebiT: SenarCunebuli sicocxlis wlebi, uunarobis periodis Semokleba, arteriuli wnevis donis daqveiTeba da a.S. • nakli: • zogjer erTi fizikaluri gamosavali ar asaxavs mkurnalobis Sedegebs yvela ganzomilebaSi

  37. Cost benefit-Rirebuleba-sargeblis analizi jandacviTi proeqtis ganxorcielebis alternativebis Sefasebis ekonomikuri meTodi, romelic mdgomareobs saqmianobis Rirebulebisa da mosalodneli sargeblis SedarebaSi fulad erTeulSi gazomviT

  38. Rirebuleba-utilizaciis analizi • ekonomikuri Sefasebis analizi, romelic erTmaneTTan akavSirebs jandacvis proeqtis fulad Rirebulebas da Sedegebis qmediTobas, cxovrebis xarisxsa da sxva indikatorebze maTi dadebiTi zegavlenis TvalsazrisiT • xarjebi izomeba monetaruli formiT • gamosavlebi-QALY-iT

  39. mtkicebebze damyarebuli medicinidan mtkicebebze damyarebuli jandacvisakenEBM to EBC The three Rs& three Es RDoing the right things marTebuli saqmeebis keTeba In the right way sworad keTeba For the right price keTeba swor fasad E Efficacyefeqtianoba Effectiveness miznobrivi efeqtianoba Efficiency efeqturoba

  40. mtkicebaze dafuZnebuli medicinidan mtkicebaze dafuZnebuli jandacvisaken

  41. samedicino momsaxurebis xarisxis uzrunvelyofa zogad praqtikaSi

  42. auditi da praqtikis menejmenti- samedicino momsaxurebis xarisxis uzrunvelyofis safuZveli "samedicino momsaxurebis xarisxi~ es aris saqmianobis is done, romelzec individebisa da mosaxleobisaTvis gaweuli samedicino momsaxureoba SesabamisobaSia Tanamedrove profesiul codnasTan da maRali albaTobiT ganapirobebs janmrTelobis mdgomareobis sasurvel maxasiaTeblebs" (US Institute of Medicine)

  43. ra sargebloba moaqvs auditis danergvas zogadi praqtikisaTvis • amcirebs frustracias • moaqvs saWiro cvlilebebi • aumjobesebs efeqtianobas • aumjobesebs efeqturobas • demonstrirebas ukeTebs karg momsaxurebas • pasuxobs pacientis saWiroebebsa da molodins • iwvevs saganmanaTlebli procesis stimulirebas • amkvidrebs ufro maRal standartebs • xels uwyobs finansuri resursebis mozidvas • amcirebs samedicino (organizaciuli da klinikuri) Secdomebis risks

  44. samedicino auditi • samedicino auditi-es aris meTodi (instrumenti), romelsac iyeneben janmrTelobis profesionalebi imisaTvis, rom sistematurad Seafason, ganaviTaron da gaaumjobeson pacientisaTvis miwodebuli samedicino momsaxureba, raTa gaumjobesdes maTi janmrTeloba da sicocxlis xarisxi. • "samedicino auditi-es aris samedicino momsaxurebis xarisxis sistematuri kritikuli analizi". ZiriTadi SekiTxvebi  • aris Tu ara is, rasac Cven vakeTebT, swori? • ras vakeTebT arasworad? • SegviZlia Tu ara ukeT vakeToT? • ras niSnavs xarisxi pacientisaTvis?

  45. Aauditis samuSao CarCo • struqtura-fizikaluri atributika, rogoricaa Senoba, aRWurviloba, pjg-is wevrebis raodenoba da kvalifikacia, dokumentacia-Canawerebi. mokled, komfortuli garemo, swori aRWurviloba, Sesaferisi adamianebi, Canawerebisa da organizaciuli sistemebis dizaini-Camoyalibeba da a.S. • procesi-aRwers personalis profesionalur praqtikas, rac warmoadgens moqmedebebisa da gadawyvetilebebis erTobliobas, asaxavs damokidebulebas, codnasa da unar-Cvevebs, mimarTulia pacientis sasargeblod. droTa ganmavlobaSi praqtikis moqmedebebSi yalibdeba mag., gasinjvis, rCeva-darigebis, wamlis daniSvnis, referalis, gamokvlevebis gamoyenebis, gadawyvetilebis miRebis nimuSebi. auditi ikvlevs swored am nimuSebs jandacvis mniSvnelovan aspeqtebze. • gamosavali-es aris janmrTelobis gansazRvruli indikatorebi. isini aRweren efeqturobas, afaseben sargebels pacientisaTvis-socialuri funqcionirebis, fsiqologiuri funqcionirebis, fizikuri funqcionirebis, pacientis kmayofilebis TvalsazrisiT.

  46. auditis dagegmareba- 10 saxelmZRvanelo wesi (gaidlaini) • 1. ganisazRvros problemis buneba • 2. naTeli, werilobiTi amocanebis dasma-unda iyos araambiciuri, Sesrulebadi, realuri (smart) • 3. Sesaferisi meTodis SerCeva-roca amocana naTelia da sworadaa dasmuli, meTodic advilad SeirCeva • 4. gadawyvetilebebis SerCeva-gamoiyeneba informaciis retrospeqtuli an prospeqtulad monacemTa Segrovebis safuZvelze • 5. analizi-gamoiyeneba cxrilebisa da grafikebis Sedgenis, monacemTa dajgufebis, da sxv. meTodebi

  47. auditis dagegmareba- 10 saxelmZRvanelo wesi (gaidlaini) 6. unda ganisazRvros vin unda iyos CarTuli-Sedegebze pasuxismgeblobis gaziarebis mizniT 7. unda daviwyoT mcirediT, yuradReba unda gamaxvildes ZiriTad aspeqtebze 8. drois Skala unda iyos xanmokle-nabij-nabij mivaRwioT mizans 9. cvlilebebis marTva-mivuTiToT, ra saxis 10. cvlilebebis moxdena SeiZleba realurad

  48. saWiroebebis Sefaseba da cvlilebebis marTva unda gvaxsovdes, rom: • aucilebelia efeqturi cvlilebebis moxdena auditiT gansazRvruli Sedegebis aRmosafxvrelad • regularuli auditireba, monitoringi praqtikis menejmentis gegmis integraluri nawilia • amocanebis dasma, dagegmareba, saimedo informaciis saWiroeba da gunduri muSaoba, saerToa praqtikis menejmentisa da auditisaTvis • amrigad, erTdroulad, auditis gareSe da swori menejmentis gareSe, sadac auditi funqcionirebs da misi Sedegebi inergeba, audits Rirebuleba ar gaaCnia.

  49. Ffaqtebis difuziamodelebi • rojersi • lomasi • logani&grehemi

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