Cardiovascular

Assessing 5-Year Outcomes of a Teamlet Care Model in Singapore Polyclinics: A Matched Difference-in-Difference Analysis.

TL;DR

Restructuring polyclinic workforces into smaller collaborative teams improved care processes and decreased high-cost health care utilization, with overall cost savings totaling SGD $2,186 per patient over 5 years.

Key Findings

The teamlet care model achieved modest clinical improvements in glycated hemoglobin for a specific subgroup of diabetes patients.

  • HbA1c decreased by 0.1% for subgroups with nonincreasing HbA1c before empanelment
  • The improvement was limited to those who did not have increasing HbA1c trajectories prior to enrollment
  • The teamlet model was introduced in 2014 and the study assessed 5-year outcomes
  • Analysis used difference-in-differences methodology controlling for individual and cohort-time fixed effects

The teamlet care model resulted in small but measurable reductions in systolic blood pressure and LDL cholesterol.

  • Systolic blood pressure decreased by 0.65 mm Hg compared with control patients
  • Low-density lipoprotein cholesterol decreased by 0.03 mmol/L compared with control patients
  • These findings come from a retrospective matched cohort study of patients with diabetes, hypertension, or hyperlipidemia
  • Outcomes were compared with matched control patients receiving usual care

Diabetes screening adherence improved substantially under the teamlet model.

  • 16% more foot screenings were completed compared with control patients
  • 6% more eye screenings were completed compared with control patients
  • These represent improvements in care process adherence rather than clinical outcomes
  • The teamlet comprised 2 family physicians, 1 nurse, and 1 care coordinator

Health care utilization shifted toward primary care, with significant reductions in high-cost inpatient and specialist services.

  • Inpatient hospitalizations decreased, generating savings of SGD $2,432 per person
  • Specialist outpatient visits decreased, generating savings of SGD $130 per person
  • Emergency department visits decreased, generating savings of SGD $49 per person
  • Polyclinic utilization costs increased by SGD $479 per person, reflecting the shift toward primary care

The teamlet care model produced net overall cost savings of SGD $2,186 per patient over the 5-year study period.

  • Total savings were calculated as the net of decreased high-cost utilization minus increased polyclinic costs
  • Inpatient savings (SGD $2,432) represented the largest component of cost reduction
  • The analysis drew on Singapore's Ministry of Health databases
  • Patients were enrolled in the teamlet program from 2014 to 2016 and followed for 5 years

The study used a retrospective matched cohort design with difference-in-differences analysis to evaluate the teamlet model.

  • The study population included patients with diabetes, hypertension, or hyperlipidemia enrolled from 2014 to 2016
  • Difference-in-differences analysis controlled for individual and cohort-time fixed effects
  • Data were sourced from Singapore's Ministry of Health databases
  • Matched control patients receiving usual care served as the comparator group

The teamlet model was a novel small-team care model introduced in Singapore polyclinics in 2014 to improve continuity and comprehensiveness of chronic disease care.

  • Each teamlet comprised 2 family physicians, 1 nurse, and 1 care coordinator
  • The model was designed for coordinated team-based care for patients with chronic disease
  • It was implemented within high-volume primary care polyclinic settings
  • The model aimed to improve care continuity and comprehensiveness

What This Means

This research suggests that reorganizing primary care clinics in Singapore into small, coordinated teams — each consisting of two family doctors, one nurse, and one care coordinator — led to meaningful improvements in how patients with chronic diseases like diabetes, high blood pressure, and high cholesterol received care. Over a five-year period, patients enrolled in these 'teamlet' teams were more likely to complete important preventive screenings, such as foot and eye exams for diabetes, compared to patients receiving the usual standard of care. Clinical improvements in blood sugar, blood pressure, and cholesterol were modest but present. One of the most striking findings was the impact on health care costs and where patients sought care. Patients in the teamlet model used fewer hospital inpatient services, visited specialist clinics less often, and had fewer emergency department visits. While their use of primary care clinics (polyclinics) increased slightly in cost, the savings from avoided hospitalizations and specialist visits far outweighed this increase, resulting in an overall saving of approximately SGD $2,186 per patient over five years. The largest single source of savings came from reduced hospital admissions, which saved an average of SGD $2,432 per person. This research suggests that structuring primary care around small, collaborative teams can shift care away from expensive hospital-based settings toward more affordable community-based primary care, while also improving adherence to recommended health screenings. These findings may be relevant for health systems in other countries looking for ways to manage growing numbers of patients with chronic diseases more efficiently and cost-effectively.

Have a question about this study?

Citation

Wye Wong S, Tan K, Pang J, Wong V, Liang Ng D, Yung Tan D, et al.. (2026). Assessing 5-Year Outcomes of a Teamlet Care Model in Singapore Polyclinics: A Matched Difference-in-Difference Analysis.. Annals of family medicine. https://doi.org/10.1370/afm.250635