Heat a large skillet over medium-high heat and cook the ground beef with the onion, garlic, Italian seasoning, dry parsley, red pepper flakes, salt, and pepper, until fully cooked.
Add the tomato paste and Worcestershire sauce and stir until fully combined.
Pour in the beef broth, add the elbow macaroni, stir, and bring to a simmer. Cover and cook for 10 minutes, stirring occasionally, until al dente.
Uncover and add the milk, sour cream, and half of the cheddar cheese. Stir until fully combined and the cheese is melted.
Top with the remaining cheese, cover, and heat for 2-3 minutes or until the cheese is melted. Serve while hot.