关键词: 社区卫生服务, 门诊医疗, 门诊医疗信息系统, 家庭医生签约服务, 真实世界研究

Abstract: Background　"Frequency of medical visits" is an important data that truly reflects patients' utilization of medical institutions，but there are few related researches in China，and there is no research on the relationship between visit behavior reflected by "frequency of medical visits" and contract service. Objective　To analyze the characteristics of the frequency of visits by contracted/non-contracted patients in urban primary care，as well as the factors that affect the frequency of visits by contracted populations，in order to identify the tendency of patients with different characteristics to use primary care resources and related influencing factors，help the family doctor team invest resources better，establish a more stable service relationship with patients. Methods　In January 2021，after desensitizing patients' identities，contact information，and specific disease diagnosis information，the outpatient behavior and contract status data of 13 community health service centers in Chengdu Wuhou District and their 18 service stations from 2020-01-01 to 2020-12-31 were extracted. The frequency of patient visits and its influencing factors were analyzed. Results　In 2020，a total of 300 634 adults visited community health service institutions，and 1 243 436 outpatient records were generated. The average age of outpatient visits was（51.5±18.4） years，and the average frequency of outpatient visits was（4.14±5.94）. Only 9 448 patients（3.14%） had cross-community health service visiting behavior，among which only 17 patients were contracted. 34.73%（104 399/300 634） of adults visiting community health service institutions were contracted populations，and 63.91%（794 710/1 243 436） of the total outpatient visits were contracted populations. 86.04%（168 840/196 235） of the non-contracted patients visited the hospital occasionally，69.93%（137 229/196 235） of the patients with relatively simple conditions. 52.30%（55 812/104 399） of the contracting population were treated with continuous management，and 29.90%（31 211/104 399） had relatively simple conditions. Calculated by the number of people，the rate of active appointment was 40.29%（42 061/104 399），and the rate of regular visit was 37.86%（39 522/104 399）. Calculated by frequency，the rate of active appointment was 18.58%（147 685/794 710），and the rate of regular visit was 18.12%（144 009/794 710）. There were statistically significant differences in age，medical frequency，the number of patients receiving traditional Chinese medicine services，number of clinicians，frequency of visits，and complexity of diagnosis between contracted patients and non-contracted patients（P<0.05）. The results of ordered multi-classification Logistic regression analysis showed that the degree of disease complexity，whether to make an appointment actively，whether to seek regular medical treatment，whether to use traditional Chinese medicine services，age，whether have outpatient medical insurance，contracted institution and number of doctors signing contracts were the influencing factors for the frequency of patients visit（P<0.05）. Conclusion　The contracted population in Wuhou district have established stable service relationship with family doctors. To make better use of the contracted service functions of community health service institutions，on the one hand，the number of contracted groups can be increased from the non-signing groups with the characteristics of frequent and abnormal frequent visits，high utilization of traditional Chinese medicine and have outpatient medical insurance，on the other hand，according to the characteristics of the influencing factors of the contracted population，through the adjustment of performance assessment indicators，the frequency of contracted patients can be further controlled in a reasonable interactive range for scientific and continuous management.

Key words: Community health services, Ambulatory care, Ambulatory care information systems, Contracted family doctor services, Real world research