Abstract: Background: High-quality primary health care (PHC) can reduce chronic disease complications and prevent severe cases from requiring hospitalization. However, limited attention has been given to PHC quality in rural areas of central and western China. Objective: This study aims to refine the measurement of avoidable hospitalizations using diabetes and hypertension as indicators to assess PHC quality and efficiency in these regions. Methods: Data from 61,450 hospitalizations at three county hospitals (2017-2021) were analyzed. Two categories of avoidable hospitalizations were identified: (1) PHC-preventable but currently unavoidable, and (2) PHC-preventable and currently avoidable. A multilevel logistic regression model assessed influencing factors. Results: Among hospitalizations, 18.1% for diabetes and 49.6% for hypertension were PHC-preventable but unavoidable, while 8.1% and 2.4%, respectively, were PHC-preventable and avoidable. This inefficiency led to an annual waste of approximately 2.37 million yuan. Influencing factors included demographics, health status, insurance, and hospital distance. Conclusion: PHC quality for chronic diseases in rural central and western China is suboptimal, leading to inefficiencies and resource wastage. Improving primary care capacity and PHC quality is essential for better chronic disease management.

Key words: Avoidable hospitalizations, Rural health, Chronic diseases, Primary healthcare, Central and Western China

摘要： 背景 高质量的基本卫生保健（PHC）可以通过对慢性病及时、有效、连续的干预措施，降低慢性病并发症的发生发展，从而预防患者因病情恶化严重而住院，因此可避免住院是反映PHC质量尤其是慢性病服务质量的一个重要结局性指标。目的 本文旨在完善可避免住院的测量方式，利用糖尿病和高血压患者的可避免住院情况作为指标，以分析我国中西部农村地区PHC的质量和效率。方法 利用两省三家县级医院2017-2021年间病案首页数据，根据ICD-10诊断筛选纳入61450条高血压、糖尿病相关住院，并界定两类可避免住院：(1) PHC可预防但本次不可避免、(2) PHC可预防且本次可避免，利用多因素Logistic回归模型分析可避免住院的影响因素。结果 2017-2021年间，18.1%的糖尿病住院、49.6%的高血压住院属于PHC可预防但本次不可避免住院；8.1%的糖尿病住院、2.4%的高血压住院属于基本卫生保健可预防&本次可避免住院，仅三家医院两种慢性病已造成约240万元/年的资金浪费。两类可避免住院均受到患者人口学特征、健康状况的影响；城乡居民或新农合医疗保险与更高的糖尿病两类可避免住院（OR=1.734，95%CI=1.425 - 2.110；OR=1.467，95%CI=1.110 - 1.937）和更高的高血压PHC可预防且本次可避免住院相关（OR=1.586，95%CI=1.235 - 2.037）。结论 我国中西部农村县域内慢性病基本卫生保健质量不佳，同时存在效率低下和资源浪费的问题。提升基层能力、改善基本卫生保健质量是未来慢性病防治工作的重点。

关键词: 可避免住院, 农村卫生, 慢性病, 基本卫生保健, 中西部