Abstract: Background　Integrated care is an effective strategy for improving chronic disease management, but standardized measurement tools suitable for rural China are lacking. Objective　To develop a measurement framework for integrated services among rural chronic disease patients based on formative measurement theory, and to assess the current status of these services. Methods　In January 2024, a multistage sampling method was used to survey 1 411 patients with hypertension and/or diabetes across three project counties (County A in Shanxi, County B in Henan, and County C in Zhejiang) enrolled in the baseline evaluation of Phase II of the China-Gates Foundation Rural Primary Health Care Cooperation Project. Guided by formative measurement theory, a three-dimensional framework comprising cross-level information continuity, longitudinal coordination mechanisms, and primary care integration was developed through literature review and expert consultation. Exploratory factor analysis (EFA) was used to examine construct validity (based on 330 complete cases), Cronbach's α coefficient to assess internal consistency, Pearson correlation and the variance inflation factor (VIF) to test discriminant validity, and analysis of variance (ANOVA) to test known-groups validity. Results　A total of 1 411 patients were included, comprising 845 (59.89%) with hypertension, 183 (12.97%) with diabetes, and 383 (27.14%) with both conditions. EFA extracted three factors: Factor 1 comprised the 9 indicators of Dimension 3 (primary care integration), Factor 2 the 4 indicators of Dimension 2 (longitudinal coordination mechanisms), and Factor 3 the 3 indicators of Dimension 1 (cross-level information continuity), cumulatively explaining 60.31% of the total variance, with all factor loadings >0.40. Internal consistency was good across dimensions (Cronbach's α 0.62-0.83). Inter-dimensional correlations were low to moderate (r=0.11-0.46) and all VIF values were <1.3, indicating that the dimensions were relatively independent and free of multicollinearity. Known-groups validity testing showed statistically significant differences in integrated service scores across the three counties (P<0.001), following a gradient consistent with the intensity of project implementation. The scores for the three dimensions were (0.40±0.23) for cross-level information continuity, (0.56±0.41) for longitudinal coordination mechanisms, and (0.73±0.28) for primary care integration, reflecting an unbalanced pattern of development. Conclusion　The three-dimensional measurement framework developed based on formative measurement theory demonstrates good reliability and validity and accurately identifies the unbalanced development of integrated services. It provides a standardized measurement tool for policy monitoring, regional comparison, and quality improvement of integrated services.

Key words: Integrated health services, Primary health care, Formative measurement, Measurement framework, Chronic disease management

摘要： 背景　整合服务是改善慢性病管理的有效策略，但适用于中国农村地区的标准化测量工具缺乏。目的　基于形成性测量理论，构建农村慢性病患者整合服务测量框架，并测量其整合服务现状。方法　于2024年1月，采用多阶段抽样方法，在中国-盖茨基金会农村基本卫生保健合作项目二期基线评估的3个项目县（山西省A县、河南省B县、浙江省C县）开展调查。在3个项目县抽取1 411例高血压和/或糖尿病患者进行问卷调查。基于形成性测量理论，通过文献回顾和专家咨询构建包括跨层级信息连续性、纵向协调机制、基层整合服务的三维度测量框架。采用探索性因子分析（EFA）检验构念效度（基于330例完整案例），Cronbach's α系数评价内部一致性，Pearson相关和方差膨胀因子（VIF）检验区分效度，方差分析检验已知组效度。结果　本研究共纳入1 411例慢性病患者，其中高血压患者845例（59.89%），糖尿病患者183例（12.97%），两病共患患者383例（27.14%）。EFA成功提取3个因子，因子1包含维度三（基层整合服务）的9个指标，因子2包含维度二（纵向协调机制）的4个指标，因子3包含维度一（跨层级信息连续性）的3个指标；累计解释方差为60.31%，因子载荷均>0.40。各维度内部一致性良好，Cronbach's α系数为0.62~0.83。维度间呈低至中等程度相关（r=0.11~0.46），方差膨胀因子均<1.3，表明农村慢性病患者整合服务测量框架各维度间既相对独立又无多重共线性。已知组效度检验显示，三县整合服务三维度得分比较，差异有统计学意义（P<0.001），随项目实施强度呈梯度分布。三维度得分分别为跨层级信息连续性（0.40±0.23）、纵向协调机制（0.56±0.41）、基层整合服务（0.73±0.28），呈现不均衡发展特征。结论　本研究基于形成性测量理论构建的三维度农村慢性病患者整合服务测量框架具有良好的信度和效度，能够准确识别整合服务的不均衡发展状态，可为整合服务政策监测、地区比较和质量改进提供标准化测量手段。

关键词: 整合型卫生服务, 基层卫生服务, 形成性测量, 测量框架, 慢性病管理