Impact of policy reforms on hospital-at-home services: an interrupted time series analysis of Shanghai

Abstract

Background: The global rise in elderly populations and chronic disease patients has increased the demand for hospital-at-home (HaH) services, which could help reduce hospitalization costs.

Objective: To assess the impact of two policies on the implementation of HaH services in Shanghai.

Methods: A two-stage interrupted time series (ITS) analysis with a control group was conducted to examine changes in three areas-institutional capacity, home-based medical services, and HaH beds-using 11 indicators from 2007 to -2022 across all community health service centres and hospitals providing HaH services.

Results: After the first policy was implemented, the number of institutions providing HaH services significantly increased ${(\beta }_1$ + ${\beta }_3+{\beta }_5$ + ${\beta }_7$ =8.200, $P$ <0.001). HaH beds in hospitals increased after the first policy was implemented $({\beta }_3$ = 247.717 $,$ $P$ < 0.01) but decreased after the second policy was implemented ( ${\beta }_1$ + ${\beta }_3+$ ${\beta }_9$ = -76.500, $P$ < 0.01). In community health service centres (stations), the number of active HaH beds per 10,000 population at year-end (beds/10,000 people) increased significantly after the first policy implementation ( ${\beta }_1$ + ${\beta }_3+{\beta }_5$ + ${\beta }_7$ = 0.406 $,P$ < 0.001), with a significant increase in the slope difference compared with hospitals ( ${\beta }_5$ + ${\beta }_7$ =0.429 $,P$ < 0.001).

Conclusion: These policies may increase the number of HaH institutions and beds but decrease home-based medical visits, likely due to the risks of home care and a shortage of health care personnel. Further policy support is needed to meet the growing demand for home-based services in China.

Keywords: China; Home health care; Home-based medical services; Hospital-at-home (HaH); Interrupted time series (ITS); Policy evaluation.

Fig. 1

Visual depiction of the interrupted time series design

Fig. 2

Trends in yearly total institutional capacity for community health service centres/stations and hospitals in Shanghai from 2007–2022. A Number of institutions providing hospital-at-home services (units). B Number of institutions providing hospital-at-home services per 10,000 population (units/10,000 people)

Fig. 3

Trend in yearly total home-based medical services for community health service centres/stations and hospitals in Shanghai from 2007 to –2022. A Total number of home-based medical service visits (visits). B Number of home-based medical service visits per 10,000 population (visits/10,000 people)

Fig. 4

Trends in the yearly total hospital-at-home beds for community health service centres/stations and hospitals in Shanghai from 2007 to –2022. A Number of active hospital-at-home beds at year end (beds). B Number of active hospital-at-home beds per 10,000 population at year end (beds/10,000 people). C Total number of hospital-at-home beds established during the year (beds). D Number of hospital-at-home beds established per 10,000 population during the year (beds/10,000 people)