Integrated care is an effective strategy for improving chronic disease management, but standardized measurement tools suitable for rural China are lacking.

To develop a measurement framework for integrated services among rural chronic disease patients based on formative measurement theory, and to assess the current status of these services.

In January 2024, a multi-stage random sampling method was used to survey 1 411 patients with hypertension and/or diabetes across three project counties (County A in Shanxi, County B in Henan, and County C in Zhejiang) enrolled in the baseline evaluation of PhaseⅡ of the China-Gates Foundation Rural Primary Health Care Cooperation Project. Guided by formative measurement theory, a three-dimensional framework comprising cross-level information continuity, longitudinal coordination mechanisms, and primary care integration was developed through literature review and expert consultation. Exploratory factor analysis (EFA) was used to examine construct validity (based on 330 complete cases), Cronbach's α coefficient to assess internal consistency, Pearson correlation and the variance inflation factor (VIF) to test discriminant validity, and analysis of variance (ANOVA) to test known-groups validity.

A total of 1 411 patients were included, comprising 845 (59.9%) with hypertension, 183 (13.0%) with diabetes, and 383 (27.1%) with both conditions. EFA extracted three factors: Factor 1 comprised the 9 indicators of Dimension 3 (primary care integration), Factor 2 the 4 indicators of Dimension 2 (longitudinal coordination mechanisms), and Factor 3 the 3 indicators of Dimension 1 (cross-level information continuity), cumulatively explaining 60.31% of the total variance, with all factor loadings >0.40. Internal consistency was good across dimensions (Cronbach's α 0.62-0.83). Inter-dimensional correlations were low to moderate (r=0.11-0.46) and all VIF values were <1.3, indicating that the dimensions were relatively independent and free of multicollinearity. Known-groups validity testing showed statistically significant differences in integrated service scores across the three counties (P<0.001), following a gradient consistent with the intensity of project implementation. The scores for the three dimensions were (0.40±0.23) for cross-level information continuity, (0.56±0.41) for longitudinal coordination mechanisms, and (0.73±0.28) for primary care integration, reflecting an unbalanced pattern of development.

The three-dimensional measurement framework developed based on formative measurement theory demonstrates good reliability and validity and accurately identifies the unbalanced development of integrated services. It provides a standardized measurement tool for policy monitoring, regional comparison, and quality improvement of integrated services.