Grassroots medical and health institutions in our country are responsible for providing basic public health services and basic medical services to residents. However, there are still weak service capabilities in grassroots medical care, which cannot truly meet the medical needs of the people. The construction of county-level medical and health sub centers (hereinafter referred to as "sub centers") is an important step for the country to promote the development of grassroots healthcare. The study of whether the medical service capacity has been improved before and after the construction of sub centers has significant practical significance.

To evaluate the medical service capacity of county-level medical and health sub-centers in Sichuan Province, and to provide a reference for continuously promoting the service capacity of sub-centers and primary medical and health institutions.

Taking 135 county-level medical and health sub centers built in Sichuan Province in 2023 as the research object, they were divided into five major regions: Chengdu Plain Economic Zone, South Sichuan Economic Zone, Northeast Sichuan Economic Zone, Panxi Economic Zone, and Northwest Sichuan Ecological Economic Zone. In January 2024, relying on the Sichuan Provincial Health Commission, a survey questionnaire was conducted on each center to obtain the number of beds per thousand population, the number of health technicians per thousand population, the bed utilization rate, the annual number of outpatient and emergency visits, the annual number of traditional Chinese medicine diagnoses and treatments, the annual number of hospitalizations, and the number of common diseases that can be identified and initially treated from 2021 to 2023, in order to evaluate their medical service capabilities. Using TOPSIS and rank-sum ratio (RSR) methods to comprehensively evaluate the changes in medical service capabilities of sub centers from 2021 to 2023, and using multiple stepwise linear regression analysis to identify the influencing factors of medical service capabilities.

The TOPSIS results showed that the C_i values in all regions were the lowest in 2021 and the highest in 2023. Except for the Panxi Economic Zone, there was a significant gap in the ability levels between sub centers within other regions. The RSR results showed that in 2023, the sub center capacity level of Chengdu Plain Economic Zone was the best, followed by the Northeast Sichuan Economic Zone, and the other regions were relatively poor. The results of multiple stepwise regression analysis showed that seven factors, including the number of beds per thousand population, had a positive impact on the evaluation results (P<0.05). Among them, the number of beds per thousand population (B=0.667, t=26.170, P<0.001) and the number of emergency visits (B=0.628, t=21.162, P<0.001) had the most significant impact.

The construction of sub centers has achieved significant results, but there is a significant gap between regions and institutions. Efforts can be made to promote the sustainable development of sub center and grassroots medical service capabilities through reasonable allocation of beds, strengthening talent team construction, and actively guiding grassroots medical treatment.

我国基层医疗卫生机构承担着为居民提供基本公共卫生服务和基本医疗服务的职责，但目前基层医疗仍存在服务能力弱等问题，无法真正满足群众就医需求。县域医疗卫生次中心（简称次中心）建设是国家推动基层医疗发展的重要步骤，对次中心建设前后医疗服务能力是否得到提升的研究具有较为重要的现实意义。

评价四川省次中心的医疗服务能力，为持续提升次中心及基层医疗卫生机构服务能力提供参考依据。

以四川省2023年建成的135家次中心为研究对象，并将其划分为成都平原经济区、川南经济区、川东北经济区、攀西经济区、川西北生态经济区五大区域。于2024年1月，依托四川省卫生健康委员会对各次中心进行问卷调查，获取2021—2023年的每千人口床位数、每千人口卫生技术人员数、病床使用率、年门急诊人次数、年中医诊疗人次数、年住院人数、能够识别和初步诊治的常见病病种数，以评价其医疗服务能力。采用TOPSIS法和秩和比（RSR）法综合评价次中心2021—2023年的医疗服务能力变化情况，采用多元线性逐步回归分析医疗服务能力的影响因素。

TOPSIS法结果显示，各区域相对接近程度C_i值均是2021年最低，2023年最高；除攀西经济区外，其他区域内部次中心之间能力水平差距较明显。RSR法结果显示，2023年成都平原经济区次中心能力水平最好，其次是川东北经济区，其余区域相对较差。多元线性逐步回归分析结果显示，每千人口床位数等7个因素均对评价结果有正向影响（P<0.05），其中每千人口床位数（B=0.667，t=26.170，P<0.001）和门急诊人次（B=0.628，t=21.162，P<0.001）影响最大。

四川省次中心建设具有明显成效，但区域间及机构间存在较大差距，可从合理配置床位、加强人才队伍建设、积极引导基层就诊等方面着手推动次中心及基层医疗卫生服务能力持续发展。