关键词: 社区卫生服务, 国际疾病统计分类, 实施研究综合框架, 真实世界研究, 影响因素分析

Abstract: Background　Population management is an important general practice service provided by primary care. The International Classification of Diseases（ICD） is a key diagnostic tool that is used to code and classify the morbidity data from patients' medical records，but is rarely used in primary care and research. Objective　To investigate the use of ICD-10 in primary care and its associated factors based on analyzing the practices of community health care，Chengdu's Wuhou District， for achieving the standardization of diagnosis. Methods　A questionnaire was designed in accordance with the constructs of the Consolidated Framework for Implementation Research，and used to investigate all the outpatient physicians and managers from 13 community health centers（CHCs） in Wuhou District，for understanding their perceptions of barriers and risks for achieving standardization of diagnosis by using the ICD-10. Through the back-end database of the hospital information system，trigger records and standardized rates of diagnoses made at different stages from June 2017 to October 2020，and consultation data during the application of ICD-10 between November 2019 and July 2020 were extracted. Results　83.1% of the respondents thought it was essential to promote the standardization of diagnosis in primary care. The effect of ICD-10 on the promotion of contracted family doctor service was expected to focus on population management（59.4%，95/160），risk stratification（55.6%，89/160） and diagnostic quality（53.8%，86/160）. Multiple linear regression analysis showed that population management，risk stratification，patient communication，work arrangement within the team，diagnosis quality，scientific research data acquisition based on management population，establishment of patient trust，and communication with external resources promoted the signing service of family doctors were the influencing factors of promoting the standardization of primary medical diagnosis（P<0.05）. During the use of ICD-10，the rate of questions raised by the consultation group was only 0.01%，mainly focusing on the operation of the information system（19.5%，38/195）. No self-defined diagnosis beyond the scope of ICD-10 system needed to be added；the proportion of diagnosis of most diseases increased，and the structure and order of diagnosis changed greatly. Conclusion　It is necessary to take measures to achieve standardization of diagnosis in primary care，and the ICD is an appropriate tool. Relevant research on the standardization of diagnosis and management of the application of the tool are suggested to be strengthened by the government，so as to lay a foundation for the development of data-driven primary care services.

Key words: Community health services, International Classification of Diseases（ICD）, Consolidated Framework for Implementation Research Constructs（CFIR）, Real world study, Root cause analysis