Multidisciplinary team key to chronic care.
D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D017046:Cost Savings; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000191:economics / Q000600:supply & distribution; D006801:Humans; D006278:Medicare; D010348:Patient Care Team; D010865:Pilot Projects; D014481:United States