Evaluating Urgent Care Centres to inform health system reform: evidence from Emilia-Romagna, Italy

Background

Since November 2023, Emilia-Romagna Region (Italy) has implemented Urgent Care Centres (UCC), walk-in clinics designed to manage low-acuity conditions. UCC was a rapid response to Emergency Department (ED) overcrowding, developed while a broader primary care reform, framed by Ministerial Decree 77 and Next Generation EU, was still being rolled out. An evaluation was deemed essential, given the model’s novelty and to inform the reform process.

Methods

We conducted: a population-based interrupted time series analysis (January 2022-April 2025), comparing observed low-acuity ED visits against the pre-implementation counterfactual trend, adjusted for seasonality and day-of-week effect; a retrospective cohort study (November 2023-April 2025;n=3,576,084) assessing low-acuity ED visits before and after UCC opening among residents with a UCC within 20 minutes. Results are presented as percentages of (1-Incidence Rate Ratios) with 95% confidence interval.

Results

UCCs recorded 783,620 accesses, reducing low-acuity ED visits by 200,547 compared with the counterfactual trend (-13.5;-13.9−-13.0). Low-acuity demand (UCC+ED) exceeded the predicted trend by 203,519 visits (13.7;13.2–14.2), suggesting previous unmet primary care needs. Effectiveness varies by organizational models. UCC in primary care facilities reduced low-acuity ED visits by 9.5% (-11.4−-7.6). UCC nearby/inside hospitals were effective only when sharing ED triage (-44;-45−-47). Telephone triage (-22;-24−-20), availability of first-level diagnostic equipment (-27;-29−-26), and 24-hour opening hours (-23;-25−-23) were associated with reductions in low-acuity ED visits.

Conclusions

UCC contributed to reducing low-acuity ED visits, with differences across configurations. These findings have informed the ongoing reform: UCC with shared triage will be preserved within an integrated emergency system, while the remaining will be incorporated into the reformed primary care network, with equipment scaled to demand.

Key messages

• Emergency Department overcrowding can be reduced through community-based organisational models addressing low-acuity urgent needs, with effectiveness varying across different configurations.

• Evaluating single innovations could inform broader health system reform in an evidence-based and accountable way.