Abstract: Background Since the 1970s, the World Health Organization has recognized primary health care as essential for universal health coverage. Following China's 2009 healthcare reform, the functional features theory (4Cs) for primary care was introduced. Researchers have conducted extensive studies, employing both international and localized instruments to evaluate the process quality of primary care service across diverse regions and populations in China.Objective This review synthesizes qualitative and quantitative evidence on the concepts, intensity, and health service outcome impacts of functional features in China's primary care services, offering evidence for quality assessment and improvement in China and comparable low- and middle-income countries.Methods Using the JBI mixed-methods systematic review framework, the researchers searched PubMed, Embase, Web of Science, Google Scholar, CNKI, and Wanfang for studies from January 2009 to March 2025. Two researchers screened literature using Rayyan, evaluated methodological quality with JBI tools, and synthesized qualitative and quantitative data via the convergent segregated approach to explore outcome mechanisms.Results This review included 60 studies (52 quantitative studies, 4 qualitative studies, 3 mixed-method studies). The functional features of China's primary care services can be broadly categorized into six dimensions: first contact, accessibility, comprehensiveness, continuity, coordination, and patient empowerment. Accessibility and patient empowerment are strong, while comprehensiveness is weaker. Overall, stronger functional features correlate with improved health outcomes, patient experiences, lower healthcare costs, utilization preference for primary care, and reduced hospital utilization, supported by qualitative data.Conclusion Future efforts should develop a China specific functional features framework for primary care services, create tailored measurement tools, and generate rigorous evidence to advance practice and research.

Key words: Health services, Functional features, Primary care, General practice, Systematic review

摘要： 背景 基本医疗服务是初级保健在我国医疗卫生体制内的主要表现形式。自2009年新一轮医改以来，初级保健功能特征理论被引入我国。迄今为止，我国研究人员已基于该理论，引入多种国际测量工具，并开发了部分本土测量工具，以评估我国不同地区和人群所接受的基本医疗服务的过程质量。目的 这项混合方法系统综述旨在对不同功能特征在我国基本医疗服务中的概念内涵，强度水平，以及与不同卫生服务结局的关系和影响的质性和定量证据进行系统归纳总结。方法 这项综述采用JBI混合方法系统综述框架，检索 PubMed、Embase、Web of Science、Google Scholar、中国知网和万方数据知识服务平台，涵盖了2009年1月—2025年3月发表的质性、定量及混合方法研究。两位研究人员使用Rayyan分两阶段筛选文献，并通过 JBI 方法学质量评价工具评估选入文献的方法学质量。在分别提取其中的质性和定量数据后，采用趋同分离法，首先对质性数据和定量数据分别进行合成，继而通过比较两类数据的一致性和矛盾点，将质性数据与定量数据的整合结果再次整合，并尝试通过质性数据解析定量数据所显示的，功能特征与卫生服务结局的关联性背后，可能影响后者的路径和机制。结果 共纳入了59项原创研究，包括52项定量研究、4项质性研究以及 3 项混合方法研究。我国基本医疗服务功能特征可大体划分为6个核心维度：全面性、首诊、患者赋能、可及性、持续性和协调性，但其本地内涵均较功能特征理论中的类似功能特征的理论内涵有所变异。这些特征的强度水平总体处于中 ~ 高范围。其更强的测量水平，与更好的患者健康状态、更好的患者体验、更低的医疗开支、倾向选择基层首诊，以及减少综合医院使用等多项重要卫生服务结局呈现出显著的正向关联关系，其中的前5个特征均呈现出明确的影响关键卫生服务结局的作用路径和机制。结论 这项综述证明了我国政府和社会发起基本医疗卫生服务改革，并对该领域持续投资的价值，并支持在未来通过进一步提升我国基本医疗服务的功能特征，以增强该服务改善关键卫生服务结局的能力和效果；此外，其还提示应对我国基本医疗服务功能特征开展更加广泛、细分和精确的研究。

关键词: 卫生服务, 功能特征, 初级保健, 全科医学, 系统综述