A Case Study on the Integrated Healthcare Delivery System in Xuhui District, Shanghai Best Practices and Implementation

Background: The “Six-Bed Integration” model in Kangjian Subdistrict, Shanghai, represents an innovative approach to integrated eldercare, combining three healthcare beds (family medical beds, rehabilitation/palliative care beds, and hospital beds) with three eldercare beds (home care, day care, and institutional care). This study explores the implementation challenges and systemic tensions within this model.

Methods: Using purposive sampling, professionals (N = 15) involved in the Kangjian integrated care system were interviewed through semi-structured interviews. Data were analyzed via Colaizzi’s phenomenological approach to identify key themes.

Results: The study identified three key challenges in the integrated care model: (1) Structural barriers including Medicare restrictions, bed shortages, and unclear admission criteria hindered service integration; (2) Ineffective outreach to homebound seniors and digital disparities limited service accessibility and understanding; (3) Unclear stakeholder responsibilities caused referral disputes, with nursing homes rejecting high-risk cases and discharge-bed availability mismatches worsening conflicts. These findings reveal systemic gaps in resource allocation, communication, and coordination within the integrated care system.

Conclusion: The “Six-Bed Integration” model demonstrates potential in bridging medical and social care but faces challenges in resource allocation, communication, and inter-institutional accountability. The study implies that optimizing integrated care delivery requires not only frontline training in coordination skills but also policy support to create synergistic mechanisms for resource sharing and accountability. Policy interventions must address Medicare constraints, standardize referral protocols, and enhance cross-sector collaboration to optimize integrated eldercare delivery.