Against the background of population aging and the increasing burden of chronic diseases, the traditional model of "focusing on treatment but not prevention" can hardly cope with the challenges and there is an urgent need to build a comprehensive prevention and treatment system that integrates medicine and prevention. Although many policies have been issued at the national level to promote the integration of healthcare and prevention, primary healthcare organizations still face many difficulties in the process of implementation: firstly, there is a lack of systematic guidance on the implementation pathway; secondly, the practice models in different regions vary greatly, and there is a lack of common mechanisms for refining; thirdly, the existing research focuses on the level of the healthcare community, and there is insufficient research on the model of healthcare-preventive integration of the primary healthcare organization as an independent subject. Therefore, this study focuses on primary care institutions as the core carrier, and analyzes the mechanism through multiple cases, aiming at solving the common problem of "how to achieve effective integration" and proposing optimization countermeasures.

This study analyzes the key mechanisms for primary care institutions to realize the business model of integration of chronic disease care and prevention, and provides reference for local primary care institutions to explore the service model of integration of chronic disease care and prevention that meets the actual situation of the local area.

In November 2024, a literature review was conducted to systematically collect and summarize research studies on the integration of medical treatment and disease prevention. Subsequently, building upon the four-level, seven-condition framework of the Rainbow Model, a qualitative comparative analysis (QCA) was performed on 14 cases of chronic disease management initiatives implemented by primary healthcare institutions, aiming to identify the mechanisms underlying effective integration of treatment and prevention. Semi-structured interviews were then carried out to derive actionable recommendations for optimization.

A total of four configurational pathways can effectively improve the effect of chronic disease healthcare and prevention integration in the primary community, configurational pathway 1 meso-micro integration, configurational pathway 2 micro and support element level integration, configurational pathway 3 multilevel integration and configurational pathway 4 full-level integration, the combined coverage of the four configurational pathways is 0.857, which can explain the good healthcare and prevention integration effect in most cases, and the combined consistency is 1.000 can well explain the paths that produce good healthcare defense integration effects. Service integration and functional integration are the core foundations for achieving good health care and prevention integration effects, emphasizing the importance of continuous chronic disease health management and supervision and assessment mechanisms, respectively, while system integration highlights the key role of policy support. Differences in core conditions, integration levels and support elements among the different groupings suggest that the pathway for realizing healthcare-prevention integration can be flexibly adjusted according to different regional resources and policy conditions, and is not a single model.

In order to realize the sustainable and good development of chronic disease medical and preventive integration business in primary care institutions, it is necessary to strengthen policy support and system integration at the macro level, promote multilevel collaboration and resource sinking at the meso level, strengthen service integration and focus on team staff integration to ensure continuity of health management at the micro level, and set up an effective supervision and assessment mechanism and performance incentive mechanism in terms of the support elements.