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Anesthesia and Analgesia ; 134(4 SUPPL):12-14, 2022.
Article in English | EMBASE | ID: covidwho-1820600

ABSTRACT

Background/Introduction: Amidst the COVID-19 pandemic, the sudden demand for virtual medical visits drove the drastic expansion of telemedicine across all medical specialties. Current literature demonstrates limited knowledge on the impact of telehealth on appointment adherence particularly in preoperative anesthesia evaluations. We hypothesized that there would be increased completion of preoperative anesthesia appointments in patients who received telemedicine visits. Methods: We performed a retrospective cohort study of adult patients at UCLA who received preoperative anesthesia evaluations by telemedicine or in-person within the Department of Anesthesiology and Perioperative Medicine from January to September 2021 and assessed appointment adherence. The primary outcome was incidence of appointment completion. The secondary outcomes included appointment no show and cancellations. Patient demographic characteristics including sex, age, ASA physical status class, race, ethnicity, primary language, interpreter service requested, patient travel distance to clinic, and insurance payor were also evaluated. Demographic characteristics, notably race and ethnicity, are presented as captured in the electronic health record and we recognize its limitations and inaccuracies in illustrating how people identify. Patient reported reasons for cancellations were also reviewed and categorized into thematic groups by two physicians. Statistical comparison was performed using independent samples t test, Pearson's chi-square, and Fischer's exact test. Results: Of 1332 patients included in this study, 956 patients received telehealth visits while 376 patients received in-person preoperative anesthesia evaluations. Compared to the in-person group, the telemedicine group had more appointment completions (81.38% vs 76.60%, p = 0.0493). There were fewer cancellations (12.55% vs 19.41%, p = 0.0029) and no statistical difference in appointment no-shows (6.07% vs 3.99%, p = 0.1337) in the telemedicine group (Figure 1). Compared to the in-person group, patients who received telemedicine evaluations were younger (55.81 ± 18.38 vs 65.97 ± 15.19, p < 0.001), less likely American Indian and Alaska Native (0.31% vs 1.60%, p = 0.0102), more likely of Hispanic or Latino ethnicity (16.63% vs 12.23%, p = 0.0453), required less interpreter services (4.18% vs 9.31%, p = 0.0003), had more private insurance coverage (53.45% vs 37.50%, p < 0.0001) and less Medicare coverage (37.03% vs 50.53%, p < 0.0001). Main reasons for cancellation included patient request, surgery rescheduled/cancelled/already completed, and change in method of appointment. Conclusions: In 2021, preoperative anesthesia evaluation completion was greater in patients who received telemedicine appointments compared to those who received in-person evaluations at UCLA. We also demonstrate potential shortcomings of telemedicine in serving patients who are older, require interpreter services, or are non-privately insured. Knowledge of these factors can provide feedback to improve access and equity to telehealth for patients from all backgrounds, particularly during the COVID pandemic as virtual evaluations increase. (Table Presented).

2.
International Journal of Accounting and Information Management ; : 20, 2021.
Article in English | Web of Science | ID: covidwho-1434575

ABSTRACT

Purpose - Earnings quality is of great concern to corporate stakeholders, including capital providers in international markets with widely varying regulatory pedigrees and ownership patterns. This paper aims to examine the association between the cost of equity capital and earnings quality, contextualised via tests that incorporate the potential for moderating effects around institutional settings. The analysis focuses on and compares evidence relating to (common law) UK/US firms and (civil law) German firms over the period 2005-2018 and seeks to identify whether, given institutional dissimilarities, significant differences exist between the two settings. Design/methodology/approach - First, the authors undertake a review of the extant literature on the link between earnings quality and the cost of capital. Second, using a sample of 948 listed companies from the USA, the UK and Germany over the period 2005 to 2018, the authors estimate four implied cost of equity capital proxies. The relationship between companies cost of equity capital and their earnings quality is then investigated. Findings - Consistent with theoretical reasoning and prior empirical analyses, the authors find a statistically negative association between earnings quality, evidenced by information relating to accruals and the cost of equity capital. However, when they extend the analysis by investigating the combined effect of institutional ownership and earnings quality on financing cost, the impact - while negative overall - is found to vary across legal backdrops. Research limitations/implications - This paper uses institutional ownership as a mediating variable in the association between earnings quality and the cost of equity capital, but this is not intended to suggest that other measures may be of relevance here and additional research might usefully expand the analysis to incorporate other forms of ownership including state and foreign bases. Second, and suggestive of another avenue for developing the work presented in the study, the authors have used accrual measures of earnings quality. Practical implications - The results are shown to provide potentially important insights for policymakers, creditors and investors about the consequences of earnings quality variability. The results should be of interest to firms seeking to reduce their financing costs and retain financial viability in the wake of the impact of the Covid-19 pandemic. Originality/value - The reported findings extends the single-country results of Eliwa et al. (2016) for the UK firms and Francis et al. (2005) for the USA, whereby both reported that the cost of equity capital is negatively associated with earnings quality attributes. Second, in a further increment to the extant literature (particularly Francis et al., 2005 and Eliwa et al., 2016), the authors find the effect of institutional ownership to be influential, with a significantly positive impact on the association between earnings quality and the cost of equity capital. suggesting in turn that institutional ownership can improve firms' ability to secure cheaper funding by virtue of robust monitoring. While this result holds for the whole sample (the USA, the UK and Germany), country-level analysis shows that the result holds only for the common law countries (the UK and the USA) and not for Germany, consistent with the notion that extant legal systems are a determining factor in this context. This novel finding points to a role for institutional investors in watching and improving the quality of financial reports that are valued by the market in its price formation activity.

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