Real‑world evidence to redesign community care services

Issue

The post‑COVID recovery agenda, shaped by Next Generation EU, conditioned funding for community care facilities (CCF) on medical and nursing staffing standards. In Emilia‑Romagna (Italy), Urgent Care Centres (UCCs) were introduced from November 2023 to reduce low‑acuity emergency department (ED) visits and subsequently required realignment with this framework.

Description of the problem

We evaluated the impact of UCCs on low-acuity ED use as a preliminary step to their integration into the CCF network. We conducted retrospective population-based analyses: 1) an interrupted time series analysis (January 2022-April 2025) to assess changes in ED low-acuity visits, and 2) a Poisson regression (November 2023-April 2025) to examine the association between organisational characteristics and reductions in ED low-acuity visits.

Results

Following UCC implementation, ED low-acuity visits were 13.5% lower than expected (95% CI 13.9%-13.0%), while total demand (UCC + ED) exceeded the predicted volume by 13.7% (95% CI 13.2-14.2%), suggesting unmet needs. Greater reductions were associated with shared triage (IRR 0.56, 95% CI 0.55-0.57), availability of X-ray (IRR 0.72, 95% CI 0.71-0.73) or comprehensive ultrasound availability (IRR 0.60, 95% CI 0.59-0.61), and 24-hour opening (IRR 0.77, 95% CI 0.75-0.78). These findings informed a two-track realignment: hospital-adjacent UCCs were retained within integrated urgent care, while territorial UCCs were redesigned as outpatient clinics led by general practitioners (GPs) within CCFs, with staffing and diagnostics scaled to demand. The plan, initiated in February 2026, will gradually reorganise 48 UCCs by October 2026.

Lessons

When policy standards become binding, existing models could benefit from adaptive redesign based on real-world evidence. Integrating routine data collection and analysis into practice and implementation processes can improve policy making and regulatory activity while sustaining service continuity.

Key messages

• Real-world evaluation of UCCs showed reduced Emergency Department low-acuity visits but increased overall demand, revealing unmet needs and guiding their integration into ongoing health system reform.

• Linking evaluation to policy enabled adaptive redesign: effective UCC models were integrated into emergency care, while others were transitioned into primary care based on performance and demand.