Impact of Policy Reforms on Hospital-at-Home Services: An Interrupted Time Series Analysis of Shanghai

Abstract Background The rapid growth of aging populations and chronic disease prevalence has increased demand for hospital-at-home (HaH) services, which offer home-based alternatives to traditional inpatient care. However, the policy impact on HaH service development in China remains understudied. Objective To evaluate the effects of two major policy reforms on HaH services in Shanghai from 2007 to 2022. Methods A two-stage interrupted time series (ITS) analysis with a control group was conducted. Data from Shanghai Statistical Yearbooks were used to assess changes in institutional capacity, home-based medical services, and HaH beds across hospitals and community health service centers. Eleven outcome indicators were analyzed. Results Following the first policy in 2010, the number of HaH service providers increased significantly, particularly in community health service centers (β1 + β3 + β5 + β7 = 8.200, P < 0.001). HaH beds per 10,000 population also rose (β1 + β3 + β5 + β7 = 0.406, P < 0.001). However, home-based medical visits declined after both policies (β1 + β3 + β5 + β7 = −90,214.350, P < 0.01), likely due to workforce shortages and service delivery risks. After the second policy in 2020, hospital-based HaH beds decreased (β1 + β3 + β9 = −76.500, P < 0.01). Conclusion While policy reforms expanded HaH service capacity, challenges remain in sustaining home-based medical visits and ensuring workforce supply. Future policies should prioritize multidisciplinary care teams and address barriers to home-based geriatric healthcare to meet the needs of China’s aging population.