Integrating urgent care centers into primary care networks to reduce emergency department overcrowding: a real-world implementation and evaluation

Emergency Department (ED) overcrowding is a major challenge for health systems and is often driven by high volumes of low-acuity visits. In 2023, the Emilia-Romagna Region in Italy implemented a network of community-based Urgent Care Centers (UCCs) to provide timely care for low-complexity urgent conditions and reduce pressure on EDs. This study examined the association between UCC implementation and low-acuity ED utilization and assessed whether the observed patterns differed by territorial context and organizational model. We conducted a retrospective, population-based time-series study using routinely collected regional health databases from January 2022 to April 2025. The study population included residents of 32 health districts in which at least one UCC was established. We described UCC characteristics and compared the case mix of UCC and low-acuity ED visits. In the areas covered by the 32 health districts considered, changes over time in daily low-acuity ED visit volumes associated with the staggered opening of UCCs were estimated using an interrupted time-series design and segmented regression models, accounting for temporal trends and annual and weekly seasonality. Analyses were stratified by degree of urbanization and by three different organizational models in urban areas. Factors associated with UCC versus ED use were assessed using multilevel logistic regression models that included patient-level and facility-level characteristics as covariates. By April 2025, 43 UCCs were operating: 48.8% were in Community Health Centers, 37.2% were located within hospitals, and 46.5% offered 24/7 coverage. On average, since the opening of the first UCC, daily low-acuity ED visits were 13.5% lower than expected (95% CI, − 13.9% to − 13.0%). The effect of UCC openings on ED activity increased alongside the progressive expansion of the regional UCC network, reaching − 22.5% (95% CI, − 23.2% to − 21.8%) and − 23.6% (95% CI, − 24.1% to − 23.1%) in the later periods. Effects varied by organizational model: a shared pre-triage model reduced low-acuity ED visits by 42.2% (95% CI, − 43.4% to − 42.9%), whereas hospital-adjacent UCCs without shared pre-triage showed a minimal reduction in ED visits (− 0.7%; 95% CI, − 2.7% to 1.5%), and community-based UCCs located far from hospitals produced modest reductions (− 9.5%; 95% CI, − 11.4% to − 7.6%). The strongest predictor of UCC use was the presence of a UCC in the municipality of residence, which increased the likelihood of using a UCC rather than an ED by approximately sevenfold. Community-based UCCs showed a substantial reduction in low-acuity ED attendances, with the greatest benefit observed when UCCs were integrated into a shared access and pre-triage pathway. Organizational design appears critical to achieving ED decongestion and optimizing urgent-care delivery. However, because no contemporaneous untreated comparator was available, the observed differences should not be interpreted as effects attributable solely to UCC implementation.