Against the background of population aging and the increasing burden of chronic diseases, the traditional model of "focusing on treatment but not prevention" can hardly cope with the challenges and there is an urgent need to build a comprehensive prevention and treatment system that integrates medicine and prevention. Although many policies have been issued at the national level to promote the integration of healthcare and prevention, primary healthcare organizations still face many difficulties in the process of implementation: firstly, there is a lack of systematic guidance on the implementation pathway; secondly, the practice models in different regions vary greatly, and there is a lack of common mechanisms for refining; thirdly, the existing research focuses on the level of the healthcare community, and there is insufficient research on the model of healthcare-preventive integration of the primary healthcare organization as an independent subject. Therefore, this study focuses on primary care institutions as the core carrier, and analyzes the mechanism through multiple cases, aiming at solving the common problem of "how to achieve effective integration" and proposing optimization countermeasures.

This study analyzes the key mechanisms for primary care institutions to realize the business model of integration of chronic disease care and prevention, and provides reference for local primary care institutions to explore the service model of integration of chronic disease care and prevention that meets the actual situation of the local area.

In November 2024, a literature review was conducted to systematically collect and summarize research studies on the integration of medical treatment and disease prevention. Subsequently, building upon the four-level, seven-condition framework of the Rainbow Model, a qualitative comparative analysis (QCA) was performed on 14 cases of chronic disease management initiatives implemented by primary healthcare institutions, aiming to identify the mechanisms underlying effective integration of treatment and prevention. Semi-structured interviews were then carried out to derive actionable recommendations for optimization.

A total of four configurational pathways can effectively improve the effect of chronic disease healthcare and prevention integration in the primary community, configurational pathway 1 meso-micro integration, configurational pathway 2 micro and support element level integration, configurational pathway 3 multilevel integration and configurational pathway 4 full-level integration, the combined coverage of the four configurational pathways is 0.857, which can explain the good healthcare and prevention integration effect in most cases, and the combined consistency is 1.000 can well explain the paths that produce good healthcare defense integration effects. Service integration and functional integration are the core foundations for achieving good health care and prevention integration effects, emphasizing the importance of continuous chronic disease health management and supervision and assessment mechanisms, respectively, while system integration highlights the key role of policy support. Differences in core conditions, integration levels and support elements among the different groupings suggest that the pathway for realizing healthcare-prevention integration can be flexibly adjusted according to different regional resources and policy conditions, and is not a single model.

In order to realize the sustainable and good development of chronic disease medical and preventive integration business in primary care institutions, it is necessary to strengthen policy support and system integration at the macro level, promote multilevel collaboration and resource sinking at the meso level, strengthen service integration and focus on team staff integration to ensure continuity of health management at the micro level, and set up an effective supervision and assessment mechanism and performance incentive mechanism in terms of the support elements.

在人口老龄化与慢性病负担加剧的背景下，传统的"重治轻防"模式已难以应对挑战并亟须构建医防融合的综合防治体系。尽管国家层面已出台多项政策推动医防融合，但基层医疗卫生机构在实施过程中仍面临诸多困境：一是缺乏系统性的实施路径指导；二是各地实践模式差异较大，缺乏共性机制提炼；三是现有研究多聚焦于医共体层面，对基层医疗卫生机构作为独立主体的医防融合模式研究不足。因此本研究聚焦基层医疗卫生机构这一核心载体，通过多案例进行机制分析，旨在破解"如何实现有效融合"的共性路径问题并提出优化对策。

分析基层医疗卫生机构实现慢性病医防融合业务模式的关键实现机制，为各地基层医疗卫生机构探索符合当地实际情况的医防融合式慢病管理服务模式提供参考。

于2024年11月采用文献研究法梳理、总结医防融合的文献案例，然后借鉴彩虹模型的4个层面、7个条件运用定性比较分析针对基层医疗卫生机构开展的慢性病医防融合业务的14个案例进行良好慢性病医防融合效果的实现机制探索，进而开展半结构化访谈提出优化意见。

共有4条组态路径能有效提升基层社区慢性病医防融合效果，组态路径1中微观整合型、组态路径2微观及支持要素层整合型、组态路径3多层面整合型和组态路径4全层面整合型，4条组态路径的组合覆盖率0.857，能够解释大多数案例中的良好医防融合效果，组合一致性1.000，能够很好地解释良好医防融合效果的产生路径。服务整合和功能整合是实现良好医防融合效果的核心基础，分别强调连续的慢性病健康管理和监督考核机制的重要性，而系统整合则凸显了政策支持的关键作用。不同组态在核心条件、整合层面和支持要素上的差异表明，医防融合的实现路径可因地区资源和政策条件的不同而灵活调整，并非单一模式。

为实现基层医疗卫生机构慢性病医防融合业务的可持续良好发展，需要从宏观层面加强政策支持和系统整合，中观层面促进多层面协作和资源下沉，微观层面强化服务整合、注重团队人员整合以确保健康管理的连续性，支持要素方面建立有效的监督考核机制和绩效激励机制。