At present, the unbalanced and inadequate development of primary healthcare services does not meet people's growing demand for them in the new era. Identifying the influencing factors and their action paths on the performance of primary healthcare services has always been an issue of common concern in the academic circles.

To clarify the combination of multiple factors and their action paths that affect the performance of primary healthcare services in China, and to provide decision-making basis for further improvement of primary healthcare services.

The study was conducted from November 2022 to August 2023, and the data were obtained from the 2021 China Health Statistics Yearbook and the 2021 China Statistical Yearbook. A fuzzy set qualitative comparative analysis (fsQCA) was conducted with the performance of primary healthcare services in 31 provinces (autonomous regions and municipalities) as the outcome variables, and application of big data, medical technology, government attention, system integration, medical resources and health demand as the conditional variables.

The quality of performance of primary healthcare services is the result of a combination of various factors. The results of configuration analysis show that there are 4 configurations to improve the performance of primary healthcare services, which can be classified into 3 patterns: "technology-environment" "organization-environment" and "technology-organization-environment". Configuration 1: Application of Big Data * - Medical Technology * - Government Attention * - System Integration * Medical Resources. Configuration 2: -Application of Big Data * - Medical Technology * System Integration * Medical Resources * - Health Demand. Configuration 3: Application of Big Data * Medical Technology * System Integration * Medical Resources * Health Demand. Configuration 4: Application of Big data * - Government Attention * System Integration * Medical Resources * Health Demand. (* means "and", - means "non"). The consistency of the four configuration solutions was 0.926, the coverage of the solution was 0.612, the original coverage ranged from 0.314 to 0.396, and the unique coverage was from 0.017 to 0.083. The configurations that improve the performance of primary healthcare services are different in eastern, central and western regions of China.

At present, increasing the investment of medical resources at the grass-roots level is still a universal measure to improve the performance of primary healthcare services in China, but attention should also be paid to effectively combine technological, organizational and environmental (T-O-E) conditions. The action paths of the influencing factors are notably different in the eastern, central and western regions of China. Therefore, regions should choose different action paths based on their own development endowments and conditions, reasonably allocate limited medical resources, improve TOE conditions in a targeted manner, so as to improve the performance of healthcare services and realize the high-quality development of primary healthcare services.