关键词: &ldquo, 1+1+1&rdquo, 签约；社区首诊；居民意愿；影响因素分析

Abstract: Objective　To investigate the willingness and associated factors of initial diagnosis at the community level among residents in the mode of "1+1+1" hierarchical medical system.Methods　Six hundred community residents were selected by random sampling method in Weifang Community Health Service Center，Pudong New Area from October to December 2017.A structured questionnaire designed by our research team consisting of questions about demographic characteristics，awareness level and signing situation of the "1+1+1" hierarchical medical system，medical treatment in community health services and first choice of medical institutions was used.A total of 600 questionnaires were distributed and 580 were recovered，with an effective recovery rate of 96.7%.Results　Of the 580 participants，463 subjects（79.8%） had the willingness of having first diagnosis at the community level.There were no significant differences in willingness of first diagnosis at the community level among residents in terms of gender，age，education level，marital status，family average monthly income，medical insurance payment method（P>0.05）.Residents who were aware of "1+1+1" hierarchical medical system had significantly higher willingness of having initial diagnosis in community service centers than those who were unaware of（P<0.05）.Residents who signed the contract had the same higher willingness than those un-signed（P<0.05）.Higher willingness of initial diagnosis at community medical services occurred in communities with fixed doctors（P<0.05）.Residents who were satisfied with doctors' service had significantly higher willingness of having initial diagnosis in community medical services than those who were neutral/unsatisfied（P<0.05）.Multivariate Logistic regression analysis showed that choice of signing "1+1+1" and continuity of care are factors influencing the willingness of initial diagnosis at the community level（P<0.05）.Conclusion　The "1+1+1" signing mode can improve the willingness of residents to have their first diagnosis in the community medical services，which will promote an orderly medical pattern.

Key words: "1+1+1", signing mode；Initial diagnosis at community levels；Willingness of residents；Root cause analysis