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

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.