Real‑world evidence to redesign community care services
Abstract
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.
Related
- Independent association of the CHG index with cardiometabolic multimorbidity: real-world evidence from community and clinical datasets.
- Cardiovascular Risk Assessment in Childhood: Focus on Family History and Lifestyle Habits in the Real-World, Cross-Sectional, Community-Based RISCAPED Study
- Real-world evidence of physical comorbidity patterns and all-cause mortality in patients with mental disorders.
- Real-world evaluation of a multilingual agentic retrieval-augmented clinical AI framework for evidence-grounded medical decision support
- 445 Co-mutation architecture shapes immunotherapy outcomes in KRAS-mutant NSCLC: real-world evidence from AACR GENIE BPC cohort
BibTeX
@article{marinelli2026realworld,
title = {{Real‑world evidence to redesign community care services}},
author = {S Marinelli and N Caranci and D Fortuna and D Tedesco and D Golinelli and M Pescetelli and M Quargnolo and M Alberani and B Perna and I Camplone},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.510},
url = {https://doi.org/10.1093/eurpub/ckag169.510},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Real‑world evidence to redesign community care services
AU - S Marinelli
AU - N Caranci
AU - D Fortuna
AU - D Tedesco
AU - D Golinelli
AU - M Pescetelli
AU - M Quargnolo
AU - M Alberani
AU - B Perna
AU - I Camplone
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.510
UR - https://doi.org/10.1093/eurpub/ckag169.510
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -