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Barbara Starfield (1932-2011)

By Martin Fortin

Professor Barbara Starfield, a prominent figure in primary care and other fields, died suddenly in California on Friday 10 June 2011. My colleagues and I would like to express our sincere condolences to her family, friends and colleagues.

Dr. Starfield made landmark contributions in primary care. The coexistence of multiple diseases did not escape her attention. Before the introduction of the concept of multimorbidity, Dr. Starfield realized that people should be characterized by their morbidity burden, and her work led to the development of an important methodological tool for assessing diagnosed morbidity burden: the Adjusted Clinical Groups system.1 With its use, populations can be described according to the mix of types of all conditions they experience in any given time period (including signs and symptoms as well as all types of diagnoses).

The subjects of comorbidity and multimorbidity are present in several of her publications,2-5 and my colleagues and I had the privilege of motivating her to write an editorial on one of our publications.6

In the June 9, 2011 posting that precedes this one, I brought to your attention the essential ideas I found in her last editorial published this year, which was also dedicated to co- and multi-morbdity.7 In essence, she alerted us to the fact that “it is not chronicity per se that creates a burden on the health-care system… it is the number of types of conditions, that is, multi-morbidity “.7 I believe it is our duty to honour her visionary statement and carry on her legacy.

Thank you Dr. Starfield for your inspiration.

1. Starfield B, Weiner J, Mumford L, Steinwachs D. Ambulatory care groups: a categorization of diagnoses for research and management. Health Services Research. 1991;26(1):53-74.
2. Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP. Comorbidity: implications for the importance of primary care in ‘case’ management. Ann Fam Med. May-Jun 2003;1(1):8-14.
3. Starfield B, Lemke KW, Herbert R, Pavlovich WD, Anderson G. Comorbidity and the use of primary care and specialist care in the elderly. Ann Fam Med. 2005;3:215-222.
4. Valderas JM, Starfield B, Roland M. Multimorbidity’s many challenges: A research priority in the UK. BMJ. Jun 2 2007;334(7604):1128.
5. Starfield B. Co-morbidity and its challenges for quality of primary care. Rev Port Clin Geral. 2007;223:179-180.
6. Starfield B. Threads and yarns: weaving the tapestry of comorbidity. Ann Fam Med. 2006;4:101-103.
7. Starfield B. Challenges to primary care from co- and multi-morbidity. Prim Health Care Res Dev. 2011;12:1-2.

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