Background and Objective:
The Italian National Recovery and Resilience Plan and the National Decree (ND) n.77 boosted the reorganisation of community-based care focusing on Community Health Homes, an evolution of Healthcare Homes (HH), previously introduced in some Regions. The goal is to strengthen a population management approach. The aim of this study is to analyse the state of the art of the HH in the Romagna Local Health Authority (LHA) providing a picture before the implementation of ND n. 77.

Methods:
A database with 130 variables describing the 38 HH of the LHA was built. The 38 HH were geolocalised, their Hub&Spoke networks mapped, and the organisation of General Practitioners (GPs) explored. An organisational analysis was performed for 7 HH through semi-structured interviews to key stakeholders. Results were validated with professionals.

Results:
The territorial distribution of HH is variable. GPs are present in every HH, but 40% of the GPs operate outside these structures. 35 out of 38 HH have a nurse-led ambulatory for chronic patients. Informal communication with GPs and specialists is favoured by spatial contiguity. Occasionally, electronic platforms shared among professionals are available. Social services are present in less than half of the HH. Community building activities are present but vary depending on the context. The HH organisational manager is always a nurse, supported by a board with different professionals and institutional actors and varying strategic or operational functions. Of note, 80% of the considered HH are former hospitals.

Conclusion:
Different professional composition and managerial solutions emerged. Each HH is based on “contingent” pillars that affect organisational design. There is no one best way to organise services, rather a best fit: the trade-off between standardisation and personalisation must be found. This also implies the need of a monitoring and evaluation system to understand what works under which conditions.