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

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2024年12月18日

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Sixian Du,
Fei Luo

摘要

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 ${(\beta }_{1}$ ${(β}_{1}$ + ${\beta }_{3}+ {\beta }_{5}$ $β_{3} + β_{5}$ + ${\beta }_{7}$ $β_{7}$ =8.200, $P$ $P$ <0.001). HaH beds in hospitals increased after the first policy was implemented $({\beta }_{3}$ $(β_{3}$ = 247.717 $,$ $,$ $P$ $P$ < 0.01) but decreased after the second policy was implemented ( ${\beta }_{1}$ $β_{1}$ + ${\beta }_{3}+$ $β_{3} +$ ${\beta }_{9}$ $β_{9}$ = -76.500, $P$ $P$ < 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 ( ${\beta }_{1}$ $β_{1}$ + ${\beta }_{3}+ {\beta }_{5}$ $β_{3} + β_{5}$ + ${\beta }_{7}$ $β_{7}$ = 0.406 $,P$ $, P$ < 0.001), with a significant increase in the slope difference compared with hospitals ( ${\beta }_{5}$ $β_{5}$ + ${\beta }_{7}$ $β_{7}$ =0.429 $, P$ $, P$ < 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.