通讯作者: 刘晓云, xiaoyunliu@pku.edu.cn

DOI：10.12201/bmr.202608.00036

Association between integrated service level and outpatient care-seeking patterns among rural chronic disease patients: a cross-sectional study in three Chinese counties

• 摘要：【摘要】目的：分析农村地区慢性病患者整合服务水平与门诊就诊选择的关联，识别与基层就诊关联密切的关键维度和具体服务环节，为分级诊疗政策优化提供实证依据。 方法：基于2024年在山西、河南、浙江三省三县开展的横断面调查数据，纳入1148名自报近一年有门诊就诊经历的高血压和/或糖尿病患者。采用基于形成性测量理论构建的三维度整合服务测量框架，运用多因素Logistic回归分析整合服务得分（连续变量）与门诊基层就诊的关联；分别纳入三维度得分和核心服务指标，识别独立效应。 结果：76.7%的患者最近一次门诊选择基层就诊。调整人口学、社会经济和健康状况因素后，整合服务总分每增加1分，基层就诊可能性上升（OR=1.010，95%CI：1.001~1.020，P=0.033）。三维度分析显示，基层整合服务是唯一具有显著独立效应的维度（OR=1.020，95%CI：1.001~1.040，P=0.041）。指标层面分析显示，控制其他指标和混杂因素后，信息下传是唯一保持显著独立效应的供方服务指标（OR=1.86，95%CI：1.06~3.27，P=0.031）。转诊推荐和转诊预约对基层就诊均无显著影响。结论：整合服务水平与农村慢性病患者基层门诊就诊呈正向关联基层整合服务是具有显著独立效应的关键维度，信息下传是与基层就诊关联最强的具体服务环节。建议优先打通上级医院向基层的信息回传通道，强化基层综合服务能力的整体建设，提升转诊协调机制的服务实效。

  关键词： 整合型卫生服务；就医选择；分级诊疗；慢性病管理；基层卫生服务; ; ; ; 

   

  Abstract: Abstract Objective: To examine the association between integrated service level and outpatient care-seeking choices among chronic disease patients in rural China, identify the key dimensions and specific service components most closely associated with primary care utilization, and provide empirical evidence to inform the optimization of hierarchical medical system policies. Methods: Based on cross-sectional survey data collected in three counties across Shanxi, Henan, and Zhejiang provinces in 2024, this study included 1,148 patients with self-reported hypertension and/or diabetes who had outpatient visits in the past year. A three-dimensional integrated service measurement framework, developed based on formative measurement theory, was applied. Multivariable logistic regression was used to examine the association between the integrated service score (continuous variable) and primary care utilization for outpatient visits, with subsequent models incorporating the three dimension scores and core service indicators separately to identify independent effects. Results: Among the 1,148 patients, 76.7% chose primary care for their most recent outpatient visit. After adjusting for demographic, socioeconomic, and health status factors, each one-point increase in the integrated service score was associated with higher odds of primary care utilization (OR=1.010, 95% CI: 1.001–1.020, P=0.033). Dimensional analysis showed that primary integrated service was the only dimension with a statistically significant independent effect (OR=1.020, 95% CI: 1.001–1.040, P=0.041). Indicator-level analysis revealed that, after controlling for other indicators and confounders, downward information transmission—the extent to which primary care providers were informed of patients'' treatment at county hospitals—was the only supply-side service indicator with a significant independent effect (OR=1.86, 95% CI: 1.06–3.27, P=0.031). Neither referral recommendation nor referral appointment assistance had a significant independent effect on primary care utilization. Conclusion: Integrated service level was positively associated with primary care utilization among rural chronic disease patients. Primary integrated service emerged as the key dimension with a significant independent effect, and downward information transmission was the specific service component most strongly associated with primary care utilization. Policy efforts should prioritize establishing information feedback channels from county hospitals to primary care facilities, strengthening the overall capacity-building of primary integrated services, and enhancing the practical effectiveness of referral coordination mechanisms.

  Key words: Integrated health services; Care-seeking pattern; Hierarchical diagnosis and treatment; Chronic disease management; Primary health care

  提交时间：2026-08-17

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• 序号	提交日期	编号	操作
  1	2026-04-04	10.12201/bmr.202608.00036V1	下载

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