Integrated care and impact evaluation of the Community Health Centres in Vercelli’s ASL after one year of their opening : results from a survey and Interrupted Time Series Analysis

Introduction Recently, the Italian national health system has shifted from a hospital-based model of health services to territorial-centred solutions for the increase of people with chronic diseases and long-term needs of assistance. So, Community Health Centres (CHCs) have been recently introduced in Italy including in the Vercelli's ASL. Aims i) Describe the 5 CHCs in Vercelli's ASL; ii) Measure the level of professional integration and the perceived continuity of care by patients in CHC's area; iii) Evaluate effect of CHCs implementation on organisational, health, and economic outcomes. Method A descriptive observation was performed through individual semi-structured interviews, administrative data collection, and questionnaires to professionals worked in the 5 CHCS and to a random sample of patients living near CHCs. Questionnaires were composed by two 5 point-scales about professional integration and continuity of care. Besides, an interrupted time series analysis (ITSA) with control was performed for impact evaluation on organisational, health, and economic outcomes. Regression models were adjusted for autocorrelation and were performed by age classes. Results 37 professionals answered to the survey on integrated care. No differences emerged by the 5 CHCs for integrated care: total scores ranged from 2.3 to 3. The lowest partial scores were for communication among professionals in the last 12 months. Differences emerged between general practitioners and nurses. About patients, out of 1000, only 117 patients answered to the survey. Overall scores for continuity of care diverged between CHCS and ranged from 2.78 to 3.09. The intensity level of physician-patient relationship was very low, whereas the quality of the relationship was judged highest. Finally, the ITSA showed that the Vercelli's ASL led to a considerable reduction of inappropriate accesses to emergency departments (EDs) in comparison to control in all age classes. About health outcomes, CHCs resulted effective in hospitalizarion reduction for diabetes and COPD among adult and A better effect was seen for total accesses to EDs and accesses for several conditions, but mortality at 30 days after hospitalization dropped only in elderly. Finally, CHCS appeared to be less efficient respect to the effectiveness. Conclusion Although some weakness, this was the first attempt to measure integrated care and continuity of care perceived by patients in relation to Italian CHCs. Results suggest that invest on CHCs in isolated areas is effectiveness at organizational and health levels