Abstract: Background　Family doctor system has been given new connotations in the new round of grassroots health service reform，and have become the significant measurement for realizing the health of the whole people.At the same time, it is very important to understand the acceptance of family doctors and the main influencing factors of their contracting behavior.Objective　To analyze the influencing factors of signing a contract with a family doctor among residents in Shanghai's Hongkou District，providing theoretical basis and empirical evidence for primary care reform.Methods　This study was conducted between December 2015 and January 2016.By use of multi-stage cluster sampling，the permanent residents in Shanghai's Hongkou District were enrolled.Through the individual face-to-face interview，the status of signing a contract with a family doctor was collected，and recorded.Implementation Evaluation of the Family Doctor System in Shanghai's Hongkou District，a questionnaire designed by our research group，was used to conduct a survey among the residents，which is mainly composed of demographic data，health status（whether have chronic diseases），habit of seeking first-contact care（the preferred medical institution），overall level of satisfaction with the contracted family doctor services（CFDSs），and awareness of the CFDSs （favorable items）．Multiple Logistic regression was adopted to analyze the influencing factors of signing a contract with a family doctor among these residents.Results　Of the 900 residents，614 effectively responded to the questionnaire，giving a response rate of 68.22%.Among the respondents，401（65.31%） had signed a contract with a family doctor，but other 213（34.69%） had not.Compared with the non-contracted residents，the contracted ones had older average age，higher rates of having Shanghai hukou and chronic diseases，higher average overall level of satisfaction with CFDSs，and higher average awareness level of CFDSs，but lower retirement rate （P<0.05）．Educational level，average income per month and habit of seeking first-contact care were all significantly different between the two groups （P<0.05）．Multiple Logistic regression analysis showed that educational level，habit of seeking first-contact care，overall level of the satisfaction with CFDSs and awareness level of CFDSs were influencing factors of signing a contract with a family doctor （P<0.05）．Conclusion　Educational level，habit of seeking first-contact care，overall level of the satisfaction with CFDSs and awareness level of CFDSs are influencing factors for signing a contract with a family doctor among residents.

Key words: Family practice, Family doctors contracted services, Community health services, Root cause analysis

摘要： 背景　家庭医生制度在新一轮基层卫生服务改革中被赋予了新的内涵，成为实现全民健康的抓手。而同时，了解民众对于家庭医生的接受程度及其签约行为的主要影响因素十分重要。目的　分析上海市虹口区居民家庭医生签约行为的影响因素，为推进基层卫生改革提供理论基础与实证依据。方法　2015年12月—2016年1月采用多阶段整群抽样法对上海市虹口区常住居民进行问卷调查。记录居民家庭医生签约情况，并采用自行设计的《上海市虹口区家庭医生制度评估调查》调查问卷进行问卷调查，问卷内容主要包括基本人口学信息、自身健康状况（是否患慢性病）、首诊就医习惯（首诊医疗机构）、家庭医生签约综合满意度、家庭医生签约服务认知情况（是否清楚家庭医生签约后优惠服务内容）。并采用多元Logistic回归分析分析居民家庭医生签约行为的影响因素。结果　共发放问卷900份，回收有效问卷614份，有效回收率68.22%。其中家庭医生签约401例（65.31%），未签约213例（34.69%）。家庭医生签约居民年龄、上海本地户籍率、慢性病患病率、家庭医生签约综合满意度、家庭医生签约服务认知清楚率高于未签约居民，退休率低于未签约居民（P<0.05）。家庭医生签约与未签约居民受教育水平、月收入、首诊就医习惯比较，差异有统计学意义（P<0.05）。多元Logistic回归分析结果显示，受教育水平、首诊就医习惯、家庭医生签约综合满意度、家庭医生签约服务认知情况是居民家庭医生签约行为的影响因素（P<0.05）。结论　受教育水平、首诊就医习惯、家庭医生签约综合满意度、家庭医生签约服务认知情况分别是居民家庭医生签约行为的影响因素。

关键词: 家庭医学, 家庭医生签约服务, 社区卫生服务, 影响因素分析