Abstract: Background　"Frequency of medical visits" is an important data that truly reflects patients' utilization of medical institutions，but there are few related researches in China，and there is no research on the relationship between visit behavior reflected by "frequency of medical visits" and contract service. Objective　To analyze the characteristics of the frequency of visits by contracted/non-contracted patients in urban primary care，as well as the factors that affect the frequency of visits by contracted populations，in order to identify the tendency of patients with different characteristics to use primary care resources and related influencing factors，help the family doctor team invest resources better，establish a more stable service relationship with patients. Methods　In January 2021，after desensitizing patients' identities，contact information，and specific disease diagnosis information，the outpatient behavior and contract status data of 13 community health service centers in Chengdu Wuhou District and their 18 service stations from 2020-01-01 to 2020-12-31 were extracted. The frequency of patient visits and its influencing factors were analyzed. Results　In 2020，a total of 300 634 adults visited community health service institutions，and 1 243 436 outpatient records were generated. The average age of outpatient visits was（51.5±18.4） years，and the average frequency of outpatient visits was（4.14±5.94）. Only 9 448 patients（3.14%） had cross-community health service visiting behavior，among which only 17 patients were contracted. 34.73%（104 399/300 634） of adults visiting community health service institutions were contracted populations，and 63.91%（794 710/1 243 436） of the total outpatient visits were contracted populations. 86.04%（168 840/196 235） of the non-contracted patients visited the hospital occasionally，69.93%（137 229/196 235） of the patients with relatively simple conditions. 52.30%（55 812/104 399） of the contracting population were treated with continuous management，and 29.90%（31 211/104 399） had relatively simple conditions. Calculated by the number of people，the rate of active appointment was 40.29%（42 061/104 399），and the rate of regular visit was 37.86%（39 522/104 399）. Calculated by frequency，the rate of active appointment was 18.58%（147 685/794 710），and the rate of regular visit was 18.12%（144 009/794 710）. There were statistically significant differences in age，medical frequency，the number of patients receiving traditional Chinese medicine services，number of clinicians，frequency of visits，and complexity of diagnosis between contracted patients and non-contracted patients（P<0.05）. The results of ordered multi-classification Logistic regression analysis showed that the degree of disease complexity，whether to make an appointment actively，whether to seek regular medical treatment，whether to use traditional Chinese medicine services，age，whether have outpatient medical insurance，contracted institution and number of doctors signing contracts were the influencing factors for the frequency of patients visit（P<0.05）. Conclusion　The contracted population in Wuhou district have established stable service relationship with family doctors. To make better use of the contracted service functions of community health service institutions，on the one hand，the number of contracted groups can be increased from the non-signing groups with the characteristics of frequent and abnormal frequent visits，high utilization of traditional Chinese medicine and have outpatient medical insurance，on the other hand，according to the characteristics of the influencing factors of the contracted population，through the adjustment of performance assessment indicators，the frequency of contracted patients can be further controlled in a reasonable interactive range for scientific and continuous management.

Key words: Community health services, Ambulatory care, Ambulatory care information systems, Contracted family doctor services, Real world research

摘要： 背景　“就诊频次”是真实反映患者对医疗机构利用情况的重要数据，但国内相关研究较少，且未对“就诊频次”反映出来的就诊行为与签约服务的关系进行研究。目的　通过真实世界数据，分析城市基层门诊服务签约/非签约患者的就诊频次特征，以及影响签约患者就诊频次的因素，以期识别不同特征的患者对基层医疗资源利用的倾向性和影响因素，帮助家庭医生团队更好地投入资源，与患者建立更为稳定的服务关系。方法　于2021年1月，通过居民健康信息中心，脱敏患者身份、联系方式和具体疾病诊断信息后，提取成都市武侯区13家社区卫生服务中心及其下属18个服务站自2020-01-01至2020-12-31的门诊患者就诊行为和签约状态数据，分析患者就诊频次及其影响因素。结果　共获取2020年在社区卫生服务机构就诊的300 634例成年人的数据，产生了1 243 436次门诊记录，平均就诊年龄（51.5±18.4）岁，平均就诊频次（4.14±5.94）次。仅有9 448例（3.14%）患者会产生跨社区卫生服务机构就诊行为，其中签约患者中仅有17人。在社区卫生服务机构就诊的成年人中34.73%（104 399/300 634）为签约患者，总门诊人次中63.91%（794 710/1 243 436）为签约患者就诊。86.04%（168 840/196 235）的非签约患者为偶发就诊，69.93%（137 229/196 235）病情相对简单；52.30%（55 812/104 399）的签约患者为持续管理就诊，29.90%（31 211/104 399）病情相对简单。以人数计算，签约患者主动预约到诊率为40.29%（42 061/104 399），固定就诊率为37.86%（39 522/104 399）；以频次计算，签约患者主动预约到诊率为18.58%（147 685/794 710），固定就诊率为18.12%（144 009/794 710）。签约患者与非签约患者年龄、就诊频次、接受中医服务人数、特殊门诊就诊人数、就诊频次、诊断复杂程度比较，差异有统计学意义（P<0.05）。有序多分类Logistic回归分析结果显示：病情复杂程度、是否主动预约到诊、是否固定就医、是否利用中医服务、年龄、是否在特殊门诊就诊、签约所在机构和医生签约人群规模是患者就诊频次的影响因素（P<0.05）。结论　成都市武侯区签约患者与家庭医生已建立了较稳定的服务关系。要更好地发挥社区卫生服务机构的签约服务功能：一方面可以从频繁及异常频繁就诊、中医利用度高、特殊门诊就诊这几个特征的非签约患者入手提高签约数量；另一方面可根据签约患者的影响因素特征，通过绩效考核指标的调整，进一步将签约患者就诊频次控制在合理的互动区间，以进行科学的持续管理。

关键词: 社区卫生服务, 门诊医疗, 门诊医疗信息系统, 家庭医生签约服务, 真实世界研究