Small-team polyclinic care raised diabetes screening and cut admissions over five years

Design

Retrospective matched cohort, difference-in-differences, 5 years

Population

Polyclinic patients in Singapore with diabetes, hypertension or hyperlipidaemia enrolled 2014–2016, and matched controls

Primary outcome

Clinical measures, screening adherence, healthcare use and costs

Effect

Foot screens +16%, eye screens +6%; SBP −0.65 mmHg; net saving about SGD 2,186 per patient

From 2014, Singapore's public polyclinics reorganised chronic disease care into 'teamlets': two family physicians, a nurse and a care coordinator sharing a fixed list. This study used national databases to compare patients with diabetes, hypertension or hyperlipidaemia enrolled from 2014 to 2016 with matched patients in usual care, using a difference-in-differences analysis over five years.

Clinical changes were small: HbA1c fell by 0.1% in one subgroup, systolic pressure by 0.65 mmHg and LDL by 0.03 mmol/L. Process measures moved more: 16% more diabetic foot screens and 6% more eye screens. Care shifted towards primary care, with fewer admissions, specialist visits and emergency attendances. Net saving was about 2,186 Singapore dollars per patient, mostly from avoided admissions.

The study is observational, and matching cannot remove every difference between those enrolled and those not. But it suggests the benefit of continuity shows up in completed screening and avoided admissions more than in laboratory numbers.

• Give each patient with a chronic condition a named small team, including someone who coordinates recalls.
• Track completed foot and eye screens as a measure of team care; these moved most in this study.
• Expect little change in HbA1c or blood pressure from reorganisation alone.
• Count avoided admissions when making the case for a care coordinator post.

Why it matters

It shows where continuity actually pays off: in completed screening and avoided admissions.

Don't overread it

This was a matched observational comparison, not a randomised trial.

The statistics, in plain English

Difference-in-differences compares how much each group changed over time, rather than comparing them at one point, which removes stable differences between the groups. It cannot remove differences that change over time, such as who chose to enrol.

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