Researchers in Ontario, Canada studied whether getting care from a team of different health professionals at community health centers helped people avoid emergency room visits. They looked at data from over 138,000 patients between 2016 and 2020. About 43% of patients saw different types of providers like counselors, nutritionists, physical therapists, and community workers in addition to their regular doctor. Surprisingly, the study found that seeing more of these team members didn’t reduce emergency room visits. In fact, patients who visited more providers tended to have more ER visits, though this may be because sicker people need more help overall.

The Quick Take

  • What they studied: Whether getting care from a team of different health professionals (like counselors, nutritionists, and physical therapists) at community health centers helped people avoid going to the emergency room.
  • Who participated: 138,324 adults who received care at 71 community health centers in Ontario, Canada between 2016 and 2018. About 43% of these patients saw team-based providers in addition to their regular doctor.
  • Key finding: Patients who saw more team-based providers actually had more emergency room visits, not fewer. However, this difference wasn’t statistically significant when researchers accounted for how sick people were overall.
  • What it means for you: Team-based care at health centers may not directly reduce emergency room visits, but this doesn’t mean it’s not helpful. People who are sicker or have more health problems naturally visit more providers and the ER more often. Talk with your doctor about whether team-based care could help with your specific health needs.

The Research Details

Researchers used a method called a nested case-control study, which means they looked backward in time at health records. They examined data from patients who went to community health centers between 2016 and 2018, then tracked whether those same people visited the emergency room between 2019 and 2020. This approach allowed them to see if visiting different types of providers at the health center was connected to fewer ER visits later.

The team used a statistical tool called negative binomial regression to analyze the data. This type of analysis helps researchers understand the relationship between two things (in this case, visiting different providers and ER visits) while accounting for other factors that might affect the results, like age, income, and how sick people were.

They looked at seven different types of providers: mental health counselors, nutritionists or diet specialists, community workers, physical therapists, health promotion specialists, foot care providers, and system navigation helpers. They compared how many ER visits people had based on how many times they saw each type of provider.

This study design is important because it uses real-world health records from a large population rather than a small group in a controlled setting. This means the results reflect what actually happens in everyday healthcare. However, because researchers looked backward at existing data rather than randomly assigning people to different types of care, they couldn’t prove that team-based care directly causes fewer ER visits—they could only see if there was a connection.

The study’s strengths include its large sample size (138,324 patients) and use of actual health records from Ontario’s healthcare system, which makes the results representative of real patients. The researchers also adjusted their analysis for many factors that could affect results, like age and health status. However, the study couldn’t prove cause-and-effect relationships, only associations. Additionally, the study only looked at Ontario, Canada, so results may not apply to other regions with different healthcare systems.

What the Results Show

The main finding was surprising: patients who visited more team-based providers actually had more emergency room visits, not fewer. However, when researchers looked more carefully at the data and accounted for how sick people were, this difference wasn’t statistically significant—meaning it could have happened by chance.

When the researchers compared the actual number of ER visits to what they would have expected based on patient characteristics, they found no meaningful differences between people who saw different types of providers. This suggests that the team-based care itself wasn’t directly responsible for changes in ER visits.

The study found that almost half (43%) of adults at community health centers received some form of team-based care. This shows that many patients are already using these services, but the study couldn’t prove these services reduced emergency room visits.

The researchers didn’t report significant secondary findings related to specific provider types. The overall pattern across all seven types of providers was similar: more visits were associated with more ER visits, but this relationship disappeared when accounting for patient health status.

Previous research has suggested that team-based care can provide benefits like better management of chronic diseases and improved patient satisfaction. However, this study found no clear connection between team-based care and reduced emergency room visits specifically. This doesn’t necessarily contradict previous research—it may mean that team-based care helps in other ways (like managing conditions better or improving quality of life) that don’t directly show up as fewer ER visits.

The study has several important limitations. First, it only looked at whether people visited the ER, not why they went or how serious their visits were. Second, people who are sicker naturally visit more providers and the ER more often, which makes it hard to know if team-based care actually helps or if sicker people just use more services overall. Third, the study only included data from Ontario, Canada, so results may not apply to other places with different healthcare systems. Finally, the study couldn’t prove that team-based care caused changes in ER visits—it could only show whether there was a connection.

The Bottom Line

Based on this study alone, we cannot recommend team-based care specifically to reduce emergency room visits. However, this doesn’t mean team-based care isn’t valuable. Talk with your primary care doctor about whether seeing other providers like counselors, nutritionists, or physical therapists might help with your specific health conditions. Team-based care may help with managing chronic diseases, mental health, or lifestyle changes even if it doesn’t directly reduce ER visits. (Confidence level: Low for ER reduction; moderate for other potential benefits based on previous research)

This research matters most to people managing chronic diseases, mental health conditions, or lifestyle-related health problems. It’s also relevant to healthcare administrators and policymakers deciding how to organize primary care services. However, people with acute or emergency conditions should continue seeking emergency care as needed. This study shouldn’t change anyone’s decision to go to the ER if they have a serious health problem.

If you do receive team-based care, benefits like better disease management or lifestyle changes may take weeks to months to become noticeable. Emergency room visits may not decrease immediately or at all, even if your overall health improves in other ways.

Want to Apply This Research?

  • Track visits to different types of healthcare providers (doctor, counselor, nutritionist, physical therapist, etc.) and note any changes in how you feel, energy levels, or management of specific health conditions. Also track any emergency room visits and what prompted them.
  • If you have access to team-based care, try scheduling appointments with at least one additional provider type (like a nutritionist or counselor) that matches your health needs. Set a specific goal, such as attending 4 sessions over 2 months, and track how this affects your overall health and well-being.
  • Create a monthly health check-in where you rate your overall health, energy, and management of any chronic conditions on a scale of 1-10. Also track any ER visits and their reasons. Review these notes every 3 months to see if team-based care is helping with your specific health goals, even if it doesn’t reduce ER visits.

This study found no clear connection between team-based care and reduced emergency room visits. However, this research should not discourage you from seeking team-based care if your doctor recommends it for managing specific health conditions. Always follow your doctor’s advice about when to seek emergency care. This study reflects data from Ontario, Canada, and may not apply to other healthcare systems. If you have questions about whether team-based care is right for you, discuss them with your primary care provider.