Abstract: Background　Family doctor contracted services have been widely implemented across China. However，challenges remain in further improving the contract rate and service quality. Therefore，conducting in-depth research and analysis on residents' actual needs for these services is critically important. Objective　To analyze the differences in demand for family doctor contracted services among residents of varying ages and contract statuses in Tianjin communities using the Kano model（KM）and evaluate satisfaction levels among contracted residents. Methods　A cluster stratified sampling method was adopted to distribute questionnaires to residents in six Tianjin communities from October 2023 to January 2024. Data were collected through face-to-face interviews. A KM-based demand analysis was conducted，and satisfaction levels with contracted services were assessed. Results　A total of 600 questionnaires were collected. KM analysis categorized residents' demands as follows：Must-be attributes included community health education，diagnosis and treatment of common diseases，a 5% increase in outpatient reimbursement rates，and extended prescription services. One-dimensional attributes included home visits，and family health lifestyle guidance，referral services and comprehensive health status evaluations. Attractive attributes included family medication guidance，personalized annual health plans，home-based medical care. Indifferent attributes included health knowledge/skill development and electronic health record establishment. Demand categories varied significantly by age and contract status. The top five satisfaction items among contracted residents were：increased outpatient reimbursement rates（4.1±1.1），extended prescriptions（4.0±1.1），electronic health records（3.6±1.2），common disease treatment（3.3±1.4），and community health education（3.3±1.2）. The lowest five were：health knowledge/skill development（3.1±1.2），family medication guidance（3.1±1.3），referral services（3.1±1.0），home-based medical care（3.0±1.3），and home visits（2.9±1.2）. Conclusion　Significant differences exist in the demands for family doctor services among Tianjin residents of different ages and contract statuses. Stratified service strategies are essential to precisely align core healthcare needs with extended service provision.

Key words: Family doctor, Family doctor contracted services, Residents' needs, Tianjin, Kano model

摘要： 背景　我国家庭医生签约服务已实现全国范围内的广泛推广，但在进一步提高家庭医生签约率和签约质量的过程中仍面临着一些挑战。为此，深入调研与分析居民对家庭医生签约服务的实际需求显得尤为重要。目的　利用 Kano 模型分析天津市社区不同年龄及是否签约居民对家庭医生签约服务的需求差异，并评估签约居民满意度。方法　采用多阶段抽样方法，于 2023 年 10 月—2024 年 1 月向天津市的 6 家社区居民发放问卷，采用访问代填的方式进行资料收集，基于 Kano 模型进行居民家庭医生签约服务需求分析，同时调查居民家庭医生签约服务满意度。结果　本研究共回收 600 份问卷。基于 Kano 模型分析患者家庭医生签约服务需求发现，社区健康教育、常见病诊治、门诊报销比例提高 5%、长处方开药符合必备属性；上门出诊、家庭健康生活指导、转诊服务、全面健康状况评估符合期望属性；家庭医药指导、个人年度健康规划、家庭病房符合魅力属性；培养健康知识及技能、建立电子健康档案符合无差异属性。不同年龄、不同签约情况居民需求属性类型不同。签约居民家庭医生签约服务满意度得分前五项的为门诊报销比例提高 5%（4.1±1.1）分、长处方开药（4.0±1.1）分、建立电子健康档案（3.6±1.2）分、常见病诊治（3.3±1.4）分、社区健康教育（3.3±1.2）分；满意度得分后五项是培养健康知识及技能（3.1±1.2）分、家庭医药指导（3.1±1.3）分、转诊服务（3.1±1.0）分、家庭病房（3.0±1.3）分、上门出诊（2.9±1.2）分。结论　本研究显示天津市不同年龄及签约状态居民对家庭医生服务的需求差异显著，需分层制定服务策略以精准匹配核心医疗需求与延伸服务供给。

关键词: 家庭医生, 家庭医生签约服务, 居民需求, 天津市, Kano 模型