Starfield B
J Med Educ. 1979 May;54(5):361-9. doi: 10.1097/00001888-197905000-00001.
Specification of the characteristics unique to primary care, as distinguished from secondary and tertiary care, has been difficult. Descriptions based upon the nature of problems actually seen by practitioners or those based upon the way in which patients come for care do not adequately distinguish primary care from nonprimary care. Definitions of primary care have stressed its first-contact aspects, coordinating features, comprehensiveness, and longitudinality. While these phenomena are adequate as gross descriptors, the inability to quantify them reduces their usefulness to planners and evaluators. Offered as a solution to this problem is a model which permits these descriptors to be defined as specific interrelationships among separate aspects of the structure (accessibility, range of services, identification of the eligible population, and continuity), process (utilization and problem recognition), and outcome of care.
区分初级保健与二级和三级保健所特有的特征一直很困难。基于从业者实际所见问题的性质或基于患者就诊方式的描述，都无法充分将初级保健与非初级保健区分开来。初级保健的定义强调其首次接触方面、协调特征、全面性和纵向性。虽然这些现象作为总体描述是足够的，但无法对其进行量化降低了它们对规划者和评估者的有用性。作为解决这一问题的方案，提出了一个模型，该模型允许将这些描述定义为结构（可及性、服务范围、合格人群的识别和连续性）、过程（利用和问题识别）以及护理结果的不同方面之间的特定相互关系。
