Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Team-Based Primary Care in Chronically Ill Patients

JAMA Intern Med; ePub 2018 Nov 26; Meyers, et al

Team-based approaches to primary care transformation may benefit patients with chronic illness by reducing the use of acute care; however, it may lead to higher use among healthier patients. This according to a recent study that evaluated the association of establishing team-based primary care with patient health care use and costs. Practices participated in a 4-year learning collaborative that created and supported team-based primary care. The study included 83,953 patients accounting for 138,113 patient-years across 18 intervention practices and 238,455 patients accounting for 401,573 patient-years across 76 comparison practices. Primary outcomes included outpatient visits, hospitalizations, emergency department (ED) visits, ambulatory care-sensitive hospitalizations, ambulatory care-sensitive ED visits, and total costs of care. Researchers found:

  • Among chronically ill patients who were exposed to team-based care, there was an 18% reduction in hospitalizations, a 25% reduction in ED visits, and a 36% reduction in ambulatory care-sensitive ED visits relative to 76 comparison practices.
  • There was an increase in outpatient visits and hospitalizations among healthier patients.


Meyers DJ, Chien AT, Nguyen KH, Li Z, Singer SJ, Rosenthal MB. Association of team-based primary care with health care utilization and costs among chronically ill patients. [Published online ahead of print November 26, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.5118.