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Assessing 5-Year Outcomes of a Teamlet Care Model in Singapore Polyclinics: A Matched Difference-in-Difference
Sabrina Kay Wye Wong1, Kelvin Bryan Tan2,3,4,5, Jeanette Pang3
1NHG Polyclinics, NHG Health, Singapore sabrina.kw.wong@nhghealth.com.sg.
Background:
A novel teamlet (small team) care model was introduced in 2014 within Singapore polyclinics to improve care continuity and comprehensiveness for patients with chronic disease. Patients were enrolled in smaller teams comprising 2 family physicians, 1 nurse, and 1 care coordinator for coordinated team-based care. This study assessed 5-year outcomes focusing on clinical parameters, care adherence, health care utilization, and economic impact.
Methods:
We conducted a retrospective matched cohort study of patients with diabetes, hypertension, or hyperlipidemia enrolled in the teamlet program from 2014 to 2016. Outcomes were compared with matched control patients receiving usual care. We analyzed data from Singapore's Ministry of Health databases using difference-in-differences analysis, controlling for individual and cohort-time fixed effects.
Results:
The teamlet model achieved modest clinical improvements; glycated hemoglobin decreased by 0.1% for subgroups with nonincreasing HbA1c before empanelment, systolic blood pressure decreased by 0.65 mm Hg, and low-density lipoprotein cholesterol decreased by 0.03 mmol/L. However, diabetes screening adherence improved, with 16% more foot screenings and 6% more eye screenings compared with control patients. Health care utilization shifted toward primary care, with decreased inpatient hospitalizations (SGD $2,432 savings per person), decreased specialist outpatient visits (SGD $130 savings per person), fewer emergency department visits (SGD $49 savings per person), but increased polyclinic utilization cost (SGD $479 per person). Overall cost savings totaled SGD $2,186 per patient.
Conclusions:
Restructuring polyclinic workforces into smaller collaborative teams improved care processes and decreased high-cost health care utilization. These findings suggest that scaling team-based care models in high-volume primary care settings might improve overall health care system efficiency and costs.Abstracts available in: يبرع (Arabic), (Chinese), Francais (French), Deutsch (German),हिन्दी (Hindi), Indonesian (Indonesian), (Japanese), Portugues (Portuguese), and Español (Spanish).
