Overview
Barbara Starfield (1932–2011) was Distinguished University Professor and Director of the Primary Care Policy Center at the Johns Hopkins Bloomberg School of Public Health's Department of Health Policy and Management. She was one of the world's leading scholars of primary care quality, equity, and health policy, and a co-developer of the Adjusted Clinical Groups (ACG) case-mix measurement system. She died in June 2011, the same month her final paper on multimorbidity measurement appeared in Health Policy.
Key Contributions
- ACG System co-development: With Jonathan Weiner and colleagues at JHU, developed the Ambulatory Care Groups (later Adjusted Clinical Groups) system classifying ICD diagnoses into 32 Aggregated Diagnosis Groups (ADGs) and ~100 mutually exclusive ACG combinations; the system is the leading morbidity burden measurement tool used operationally by health systems worldwide.
- Type-based multimorbidity: Argued that the type of illness burden (ADG distribution) is a better predictor of resource use than raw condition counts; documented the resource-use paradox showing that most individuals with any single chronic condition are below-average resource users.
- Primary care policy: Authored foundational research on the four domains of primary care (first contact, continuity, comprehensiveness, coordination) and their cross-national links to health outcomes and equity; author of Primary Care: Balancing Health Needs, Services, and Technology (1998).
- Health equity: Documented SES gradients in morbidity burden using ACG-based population profiling, demonstrating non-random morbidity clustering in disadvantaged populations.
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