ABSTRACT:The United States has made progress in decreasing the black-white gap in civil rights, housing, education, and income since 1960, but health inequalities persist. We examined trends in black-white standardized mortality ratios (SMRs) for each age-sex group from 1960 to 2000. The black-white gap measured by SMR changed very little between 1960 and 2000 and actually worsened for infants and for African American men age thirty-five and older. In contrast, SMR improved in African American women. Using 2002 data, an estimated 83,570 excess deaths each year could be prevented in the United States if this black-white mortality gap could be eliminated.

Context-Satisfaction among both physicians and patients is optimal for the delivery of highquality healthcare. Although some links have been drawn between physician and patient satisfaction, little is known about the degree of satisfaction congruence among physicians and patients living and working in geographic proximity to each other.Objective-We sought to identify patients and physicians from similar geographic sites and to examine how closely patients' satisfaction with their overall healthcare correlates with physicians' overall career satisfaction in each selected site.Methods-We undertook a cross-sectional analysis of data from 3 rounds of the Community Tracking Study (CTS) Household and Physician Surveys (1996, 1998, a nationally representative telephone survey of patients and physicians. We studied randomly selected participants in the 60 CTS communities for a total household population of 179,127 patients and a total physician population of 37,238. Both physicians and patients were asked a variety of questions pertaining to satisfaction.Results-Satisfaction varied by region but was closely correlated between physicians and patients living in the same CTS sites. Physician career satisfaction was more strongly correlated with patient overall healthcare satisfaction than any of the other aspects of the healthcare system (Spearman's rank correlation coefficient 0.628, P < 0.001). Patient trust in the physician was also highly correlated with physician career satisfaction (0.566, P < 0.001).Reprints: Jennifer DeVoe, MD, DPhil, Assistant Professor, Department of Family Medicine, Oregon Health and Science University, 3181 Sam Jackson Park Rd, mailcode: FM, Portland, OR 97239. devoej@ohsu.edu. Conclusions-Despite geographic variation, there is a strong correlation between physician and patient satisfaction living in similar geographic locations. Further analysis of this congruence and examination of areas of incongruence between patient and physician satisfaction may aid in improving the healthcare system. Keywords physician satisfaction; patient satisfaction; patient-physician interactions; healthcare reform; patient surveys; physician surveys HHS Public AccessIn the past few decades, the U.S. healthcare system has undergone a major metamorphosis. As the system continues its transformation, each permutation creates new struggles to control costs, minimize errors, centralize management, increase efficiency, and avoid risk. This tumultuous environment, in part, has fueled rising physician discontent. -Dissatisfaction among physicians negatively impacts patients. Dissatisfied physicians have aberrant prescribing patterns. , Patients of unhappy doctors are less likely to adhere to necessary medical regimens. -Dissatisfied patients are also more likely to switch doctors, interrupting continuity of care and contributing to duplication of costly services. Satisfied physicians, on the other hand, are more attentive to patients and less likely to leave practice. ,-Continuity of care, access to health informati...

PURPOSE Americans who do not have health insurance receive fewer health services and have poorer health status than those who have insurance. To better understand this disparity, in this study we characterize primary care physician's perceptions of what effect, if any, patients' insurance status has on their clinical decision making during offi ce visits.METHODS Twenty-fi ve physician members of CAPRICORN, a primary care practice-based research network in metropolitan Washington, DC, completed a brief paper-card survey instrument immediately after each patient encounter during 2 half-day offi ce sessions. Participants saw patients in their usual manner and were given no additional information about their patients or their insurance.RESULTS Eighty-eight percent of participating physicians reported making at least 1 change in clinical management as a result of a patient's insurance status. They reported altering their management during 99 of 409 patient encounters (24.2%). There was a signifi cant difference in the percentage of visits that involved a change in management for privately insured, publicly insured, and uninsured patients (18.7%, 29.5%, and 43.5% respectively, P = .01). Physicians reported discussing insurance issues with patients during 62.6% of visits during which they made a change in management based on insurance status. CONCLUSION Physicians incorporate their patients' insurance status into their clinical decision making and acknowledge they frequently alter their clinical management as a result. Additional research is needed to understand the effect of these changes on patient health and to assist both physicians and patients in enhancing the quality of care delivered within the constraints of the current insurance system.

There is significant debate regarding the regulation of the sex industry, with a complex range of cultural, political and social factors influencing regulatory models which vary considerably between and within countries. This systematic review examined the available evidence on the relationship between different approaches to sex industry regulation in high-income countries, and associated effects on sex worker health status. Objectives included identification of sex worker health outcomes, including sexual health, substance use and experience of stigma and violence. A search was performed electronically in eight scholarly databases which yielded 95 articles which met the criteria for inclusion. Findings suggested that sex workers in legalised and decriminalized countries demonstrated greater health outcomes, including awareness of health conditions and risk factors.

ObjectiveThis paper explores the impact of service area-level social deprivation on health centre clinical quality measures.DesignCross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres.SettingsHRSA-funded health centres in the USA.ParticipantsOur analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country.ResultsHigher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care.ConclusionsThis research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.