Abstract: Background　China is using artificial intelligence technology to enhance the standardization and homogeneity of primary health services and drive universal health coverage. Objective　To empirically reveal the influence mechanism of artificial intelligence（AI）empowering the performance of primary health services，and propose corresponding optimization paths. Methods　A large-scale and multi-center policy pilot case on the ultrasound AI-assisted diagnostic system （the AI system）deployed in109 public medical institutions in Puyang City，Henan Province，from July 2022 to May 2024，was selected for research. Organizational Change Dynamics Model was used as the main theoretical framework，and questionnaire survey was used as the main data collection method. Descriptive statistical analysis，exploratory factor analysis，confirmatory factor analysis，variance analysis and structural equation model analysis are the main data analysis methods. Results　A total of 429 valid questionnaires were obtained. The performance evaluation index system of artificial intelligence empowering primary health services designed in this study included two dimensions：internal optimization performance and social adaptation performance. The social adaptation performance of system applications was higher than that of internal optimization. Applications not only brought about direct performance results such as improvements in medical quality and operational efficiency，but also lead to more prominent enhancements in social adaptation performance such as sustainable development and satisfaction. The main situational triggers for performance improvement were “policy environment”，“industrial support” and “technology transfer”，while the main enabling factors were “medical insurance support”，“technological level” and “purchasing power”. The three key optimization paths for enhancing the performance of primary health services empowered by artificial intelligence are “policy environment/industrial support → technological level → social adaptation performance/internal optimization performance”，“policy environment/industrial support → purchasing power → social adaptation performance”，and “policy environment/technology transfer → medical insurance support → social adaptation performance/internal optimization performance”. Conclusion　On the basis of fully understanding that the deployment of the AI system has the dual values of profitability and publicity，the public sector should adopt a variety of policy tools，starting from creating a leading and encouraging policy environment，strengthening the integrity of industrial supporting，and accelerating the cultivation of results transformation mechanism. It is essential to make efforts to improve the technical level of medical AI equipment，to strengthen the equipment purchasing ability of primary health institutions，to accelerate the inclusion of AI diagnostic applications in medical insurance payments，and to further improve the performance of AI enabling primary health services.

Key words: Artificial intelligence, Primary health services, Empowerment, Performance, Influence mechanism, Policy pilot, Structural equation model

摘要： 背景　我国正以人工智能技术提升基层卫生服务标准化与同质化水平，驱动全民健康覆盖，并展现出在数字健康领域的全球领导力。目的　实证揭示人工智能赋能基层卫生服务绩效的影响机理，并提出相应的优化路径。方法　选取2022年7月—2024年5月河南省濮阳市全域109家公立医疗机构部署的“超声人工智能辅助诊断系统”大规模、多中心政策试点案例为研究对象，以组织变革动力模型为主要理论框架，以问卷调查为主要数据采集方法，以描述性统计分析、探索性因子分析、验证性因子分析、方差分析、结构方程分析为主要数据分析方法。结果　获得有效问卷429份。本研究设计的人工智能赋能基层卫生服务绩效评价指标体系包含内部优化绩效、社会适应绩效2个维度；系统应用的社会适应绩效相较内部优化绩效要更高，应用不仅产生了医疗质量的提升、运营效率的提高等直接的绩效结果，还使得可持续发展、满意度等社会适应绩效更为突出的提升。绩效提升的主要情境触发因素是“政策环境”“产业配套”和“成果转化”，主要使能因素是“医保支持”、“技术水平”和“购买能力”。提升人工智能赋能基层卫生服务绩效的3条关键优化路径是“政策环境/产业配套→技术水平→社会适应绩效/内部优化绩效”“政策环境/产业配套→购买能力→社会适应绩效”“政策环境/成果转化→医保支持→社会适应绩效/内部优化绩效”。结论　公共部门在充分理解部署医学人工智能设备具有盈利性和公共性双重价值的基础上，应当采用多种政策工具，从创造引领性和鼓励性政策环境、加强产业配套的完整度、加快成果转化机制培育着手，在提升医学人工智能设备的技术水平、加强基层卫生机构的设备购买能力、加快人工智能诊断应用纳入医保支付等领域持续发力，进一步提升人工智能赋能基层卫生服务的绩效。

关键词: 人工智能, 基层卫生服务, 赋能, 绩效, 影响机理, 政策试点, 结构方程模型