Since the 1970s, the WHO 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.

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.

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.

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.

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.

Diabetes has become a significant global public health issue. In China, the prevalence of diabetes has been steadily increasing, placing a substantial burden on healthcare resources. The primary healthcare system plays a crucial role in diabetes management, yet there are still deficiencies in improving the quality of diabetes management services and achieving adequate blood glucose control.

This policy brief aims to explore and analyze evidence-based quality improvement interventions for diabetes management in primary healthcare settings, providing practical recommendations for policy and practice.

During July to December 2024, a systematic search was conducted using the PubMed, Epistemonikos, and Health System Evidence databases to identify relevant systematic reviews published in the past 10 years. The focus was on quality improvement interventions for type 2 diabetes management in primary healthcare systems, with an additional analysis of their effectiveness in China.

A total of 33 international systematic reviews and 22 original studies from China were included. The interventions were categorized using the Chronic Care Model (CCM), which identifies six key strategies: (1) high-quality healthcare service organization; (2) community resource linkages; (3) self-management support; (4) delivery system design; (5) decision support; and (6) information systems. Regarding the primary health outcome—blood glucose control—two types of interventions, including high-quality integrated interventions focused on service organization optimization and self-management support, showed positive effects in all studies. The evaluation of other interventions was inconsistent or lacked sufficient evidence. Studies conducted in China validated the positive effects of four intervention strategies on blood glucose control. However, evidence for the effectiveness of "enhancing community resource linkages" and "strengthening decision support" remains insufficient in China.

This policy brief summarizes effective interventions for diabetes management in primary healthcare systems, based on the best evidence available and the results from their implementation in China. It recommends prioritizing two key strategies: fostering a culture of quality improvement across the entire system and implementing a comprehensive chronic disease management model, while in areas where a full system-wide approach cannot be implemented, prioritizing interventions that support patient or community self-management. Additionally, the brief emphasizes expanding multi-sector collaboration and exploring more practices to strengthen community resource linkages, while also providing primary healthcare personnel with more direct and actionable guidelines.

Multiple chronic diseases have become an important characteristic of the development of chronic diseases, the chronic disease response method based on community health services has been recognized as one of the most cost-effective solutions, the quality of community health services affects the well-being of the public. Ratchet effect is beneficial for behavioral research, and we can provide useful reference for the evaluation of community health service quality for patients with multiple chronic diseases based on the perspective of doctor-patient behavior.

Research on the influencing factors of community health service' quality evaluation for patients with multiple chronic diseases based on ratchet effect.

Using multi-stage sampling method to select patients with multiple chronic diseases as the research subjects from 18 communities in Guangzhou, Guangdong Province, during July to August 2023. The community health service quality assessment questionnaire was used the PCAT scale developed by the Johns Hopkins Primary Care Center in the United States. Exploring the impact on the evaluation of community health service quality for patients with multiple chronic diseases under the moderation effect of medical insurance by constructing a multiple linear regression model.

We included 282 subjects with 129 males and 153 females, their average age was (38.0±8.0) years old. Married accounted for the majority of the participants, with 165 (58.51%); local residents predominated, with 215 individuals (76.24%); the distribution of educational backgrounds was balanced, with postgraduates constituting the largest group: 112 individuals (39.73%); the majority of residents' monthly income were below 5 000 yuan, with 163 individuals (57.80%); a total of 242 participants (85.81%) reported their health status as good or very good; the majority of participants were covered by public healthcare, urban employee social insurance, and urban resident social insurance, with 239 individuals (84.75%). The PCAT score for patients with multiple chronic conditions was (104.47±13.63) points. Statistically significant differences (P<0.05) were observed in PCAT scores based on different monthly income levels and health statuses. There was a statistically significant difference (P<0.05) in PCAT among institutions which had two levels of familiarity with multiple chronic diseases' patients, and the same for variations in willingness to utilize primary care services. Medical insurance had a positive moderating effect on the evaluation of community health service quality for patients with multiple chronic diseases (P<0.05). The behavior indicators of doctor-patient relationship had a ratchet effect on the evaluation of community health service quality for patients with multiple chronic diseases. That is to say, the higher the familiarity of community health service institutions with patients with multiple chronic diseases and the stronger the intention of patients with multiple chronic diseases to seek medical treatment at the grassroots level, the higher the evaluation of the quality of community health services for patients with multiple chronic diseases, it showed a phenomenon of only increasing without decreasing.

Medical insurance can enhance the evaluation of community health service quality by patients with multiple chronic conditions. The state should continue to introduce beneficial policies for improving the patients' medical experience. At the same time, we should advocate for the establishment of effective two-way communication between doctors and patients. Furthermore, we should continue to strengthen the awareness of primary care for patients with multiple chronic diseases.

Family doctor contract services (FDCS) is an important measure for deepening medical reform in China, aimed at improving people's health level and the efficiency of the health service system. FDCS has achieved rapid development in terms of quantity, but there is currently a lack of research evidence related to the quality of FDCS.

To understand the current status and existing problems of home medicine service quality in Beijing from the perspective of general practitioners, and provide reference for improving the quality of FDCS.

Eighteen general practitioners from 18 community health service institutions in 9 districts of Beijing were selected through purposive sampling from August 2023 to June 2024, and semi-structured interviews were conducted with general practitioners based on the structure process outcome framework interview outline. Analyze the data through thematic analysis and extract interview themes.

The study extracted 3 themes and 11 sub-themes. Theme 1: The structural quality of FDCS (policy guidance and implementation, institutional conditions and facilities, assessment and incentive mechanisms for FDCS, home healthcare team building). Theme 2: Process quality of FDCS (contract service content, referral and treatment service process, outpatient service standards). Theme 3: The effectiveness of FDCS (improvement in residents' health levels, increased willingness to seek medical treatment, need to strengthen residents' recognition of home medicine services, increased occupational pressure on general practitioners).

Since the implementation of home medical services, the quality of services has gradually improved, but there are still some limiting factors. We should strengthen policy support, optimize service content and processes, integrate quality evaluation systems with incentive mechanisms, enhance the comprehensive service capabilities of general practitioners and establish efficient home medical teams.

Quality of primary health care (PHC), as an important dimension of universal health coverage, is receiving increasing attention globally. A correct understanding of the concept of PHC quality is a prerequisite for measuring, evaluating, and improving quality. PHC quality in China is not clearly defined, and there is no standardized definition and evaluation methodology. Research and policies on PHC quality face enormous challenges. This systematic review searched CNKI, VIP, Wanfang, PubMed, Embase, Google Scholar as well as official websites. Thematic analysis was used for data analysis. After screening, 31 studies/reports covering both low- and middle-income and developed countries were included. The current concepts of PHC quality can be categorized into three themes: (1) content-driven definitions, (2) goals-driven definitions, and (3) characteristics-driven definitions. The content of PHC includes basic medical services, public health services, and quality improvement. The goals of PHC include safety, effectiveness, timeliness, efficiency, equity, appropriateness, patient satisfaction, and patient-centeredness. The characteristics of PHC include access, continuity, coordination, comprehensiveness, family/community-centeredness, and integration. China should define PHC quality combining the content, goals, and characteristics of PHC that considers the stage of economic and social context and health care system context.

The imbalance and uneven distribution of resources among primary healthcare institutions constitute the primary issues between urban and rural ones. To enhance the quality of primary medical services in urban and rural areas and promote standardized construction, it is of vital significance to accurately grasp the disparities in the quality of primary medical services between them.

To evaluate and compare the service quality of urban and rural primary medical institutions in Chengdu, and to analyze the impact of different patient characteristics on the quality and experience of medical services.

A survey was carried out from November 2019 to January 2020 covering all primary healthcare institutions in 22 districts (counties) of Chengdu City. In this study, all registered general practitioners' patients who had received treatment at these institutions were selected as the research subjects through a convenient sampling method. A Questionnaire on the Quality of primary healthcare services and costs (QUALICOPC) was utilized, and a questionnaire on the quality of primary healthcare services in Chengdu was compiled by integrating it with the actual situation in Chengdu. It encompasses four dimensions: accessibility, continuity, coordination, and comprehensiveness of medical services, and multiple stepwise linear regression analysis was employed to analyze the influencing factors of the quality of primary healthcare services.

A total of 2 153 patients were included, with the scores of the accessibility, continuity, coordination, and comprehensiveness dimensions of rural health clinics being (0.45±0.26) points, (0.68±0.41) points, (0.48±0.41) points, and (0.37±0.40) points, respectively. The scores of the dimensions of community health service centers were (0.45±0.27) points, (0.69±0.39) points, (0.46±0.42) points, and (0.29±0.38) points, respectively. The comprehensiveness dimension score of rural health clinics was higher than that of community health service centers, with a statistically significant difference (P<0.05). The current working conditions (rural health clinics: β=-0.031, P=0.006; community health service centers: β=-0.028, P=0.003) and whether there was a contracted doctor (rural health clinics: β=0.128, P<0.001; community health service centers: β=0.169, P<0.001) are influencing factors of the comprehensiveness of primary healthcare services.

The level of accessibility, coordination, and continuity of PHC quality in urban and rural primary medical and healthcare institutions in Chengdu is relatively high; the comprehensive score of township healthcare centers is higher than that of community healthcare service centers. The current working status has a negative prediction effect on the comprehensive service experience of primary medical and health institutions, and some contracted doctors have a positive prediction effect on the comprehensive service of primary medical and health institutions.

The national basic public health service project has been in operation for more than 10 years since its inception in 2009, and the equalization of basic public health services is one of the most urgent needs of floating population in China.

To evaluate the basic public health services quality of floating population in China, find out existing problems and provide reference for improving the services of floating population.

The quality of basic public health services of the floating population in 31 provinces (direct-controlled municipalities, autonomous regions, excluding Hong Kong, Macao and Taiwan) was comprehensively evaluated by entropy-weight Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) method using the data of China Migrants Dynamic Survey from 2015 to 2018, and the main impact indicators of the evaluation results were analyzed by multiple regression. Using Rank Sum Ratio method to grade the evaluation results.

The results of entropy-weight TOPSIS method showed that the C_i values of 31 provinces (direct-controlled municipalities, autonomous regions) range from 0.217 to 0.759. The main influencing indicators of the evaluation results were the rate of health records establishment, the rate of type 2 diabetes patients management, the rate of health check-up for children aged 0-6, the rate of health check-up for elderly aged 65 and above, the rate of health handbook establishment for children aged 0-6, the rate of visit within 28 days after delivery, the coverage rate of free pre-pregnancy health check-up for target population, the acceptance rate of health education services, the rate of pregnancy registration within 12 weeks, the basic free contraceptive coverage rate, the rate of basic free contraceptive surgical services, and hospital delivery rate. According to the RSR method, the results of evaluation were divided into 4 grades, the number of provinces (direct-controlled municipalities, autonomous regions) ranked as excellent, good, medium and poor was 2, 15, 12 and 2 respectively. The results of regional comparison showed a pattern of "Central > Western > Northeast > Eastern".

The quality of basic public health services is regionally and interprovincially uneven. We should strengthen the work of health system documentation, hypertension and diabetes management, physical examination of the elderly and children. In particular, the three major urban agglomerations in the eastern region and some mega-cities urgently need to improve the basic public health services quality of Chinese floating population.

Patients' experience as an important aspect of measuring and evaluating the quality of primary healthcare services, it's important to measure and evaluate it. However, the research about patients' experience in China started late, and there are even fewer studies focusing about patients who visit to the primary health care institutions.

To reflect the progress of primary healthcare services in China by measuring and evaluating patients' experience which from the primary health care institutions.

From March to April 2023, a patient questionnaire survey was conducted by trained and qualified investigators using an intercept method on patients of township health centers/community health service centers in 3 sample townships/streets in 12 national comprehensive primary health care pilot zones (hereinafter referred to as "the pilot zones"). The main survey tool was the Assessment Survey of Primary Care (ASPC) scale. In fact, 36 institutions and 1 157 patients were surveyed.

The scores for the dimensions of the first visit/first line care, service accessibility, continuity of the patient relationship, comprehensive services, and coordinated services for the patients surveyed who received primary healthcare services were (69.5±20.5), (74.1±20.1), (72.0±20.7), (75.1±21.0), and (68.5±21.7) respectively, with the total score of the ASPC scale being (71.8±17.3). There were statistically significant differences (P<0.05) between patients of different ages, literacy levels, employment statuses, whether they were signed up or not with prationers, and whether they were with chronic diseases as well as in the different pilot zones in all dimension scores and in total scores. The results of the multivariate linear regression analysis show that age, employment statuses, signed up or not with prationers, and different pilot zones are the influencing factors for the scores of the first visit/first line care in patient (P<0.05), while employment statuses, signed up or not with prationers and different pilot zones are the influencing factors for the scores of the other four dimensions and the total score of the scale (P<0.05). After adjusting for other factors, the scores on the five dimensions and the total score of the ASPC scale were all lower in unemployed patients than in employed patients (P<0.05). The scores on the five dimensions and the total score of the ASPC scale were all higher in patients who had signed up with prationers than in those who had not (P<0.05). The total score of the ASPC scale was higher in patients from Changting County, Xishui County than in those from Jiexiu City (P<0.05), while it was lower in patients from Haiyan County, Lu County, Dongfang City than in those from Jiexiu City (P<0.05). The total score of the ASPC scale was not statistically significant in patients from Suixi County, Shouguang City, Jiaxian County, Xinyuan County, Miyun District, and Shangsi County compared with those from Jiexiu City (P>0.05) .

The scores of ASPC reflect the current situation of primary health care services in China. The implementation of the family doctor contract service enhances the patient's experience of the first visit to the primary health care institutions, accessibility of services, continuity of the doctor-patient relationship, comprehensive services, and coordinated services. The capacity and quality of primary health service delivery varies across the pilot zones. The difference in the experience score of primary outpatients in different experimental areas is related to "patient-centered" and convenience measures.

The influence mechanism of health management on self-management behavior in patients with type 2 diabetes is still unclear.

To explore the mediating effect of core attributes of general practice between the health management and self-management behavior of type 2 diabetes in basic public health services.

From April to September 2023, this study randomly selected 1-2 community health service centers from each district of 6 urban areas in Fuzhou City. Patients with type 2 diabetes from 11 community health service centers were surveyed by general situation questionnaire, Assessment Survey of Primary Care and Summary of Diabetes Self Care Activities. Descriptive analysis and correlation analysis were conducted using SPSS 26.0, and a structural equation model was constructed using AMOS 28 for mediation testing.

A total of 483 valid questionnaires were collected. The standardized health management rate for completing all prescribed service contents was 46.2%. The score of Summary of Diabetes Self Care Activities was (27.77±10.67), and the score of Assessment Survey of Primary Care was (64.33±13.90). There was a positive correlation between standardized health management, core attributes of general practice and self-management behavior (r=0.452, 0.483, P<0.01), and standardized management was positively correlated with core attributes of general practice (r=0.638, P<0.01). The mediation analysis showed that the mediating effect of the core attributes of general practice between basic public health service and patient self-management behavior was 0.403 (95%CI=0.267-0.541) .

Core attributes of general practice may be a mediator between type 2 diabetes mellitus health management in the basic public health service and self-management behaviors of patients.

Under the background of the promotions concept change from "disease-centered" to "health-centered", Zhejiang province takes the lead in building a future community health scenario for the whole population and the whole life cycle, providing a "Zhejiang model" for the comprehensive reform of grassroots health care. It is of great theoretical significance and practical value to construct a set of scientific and effective service quality evaluation index system for future community health scene.

The purpose of this study is to construct a service quality evaluation index system for future community health scenes in Zhejiang province, aiming to provide a reference for improving the capabilities and quality of community health services and advancing the achievement of public health objectives.

Employing the SERVQUAL theory model, an initial indicators pool was developed through policy analysis, literature review, and field research. From October to December 2023, a two-round Delphi expert consultation method was used to refine the indicators, and the Analytic Hierarchy Process (AHP) was applied to determine the weights and composite weights of each indicator.

A total of 17 experts participated in both rounds of consultation, among which 12 (70.6%) hold senior titles; 15 (88.2%) have 10 or more years of work experience; and there are 5 (29.4%) managers and medical staff from future community. The positivity level of the experts in both rounds was consistently rated at 1.0, with authority coefficients of 0.862 and 0.842, respectively, and the degree of expert consensus increased round by round. The final constructed indicator system includes 5 primary indicators, 13 secondary indicators, and 36 tertiary indicators, and the weights for the primary indicators—tangibles, reliability, assurance, responsiveness, and empathy were 0.168, 0.180, 0.240, 0.174 and 0.238, respectively. For the secondary indicators, the weights for venue facilities, digital equipment, Service Provision, Health Monitoring, Service Efficiency, Service Accessibility, Crisis Prevention and Emergency Rescue Capability, Professional Skills, Activity Organization, Smart Platform Maintenance, Service Attitude and Emotional Support, Service Effectiveness and Personalized Services were 0.399, 0.601, 0.672, 0.328, 0.487, 0.171, 0.342, 0.410, 0.416, 0.174, 0.284, 0.323 and 0.393 respectively.

The indicator system constructed in this study, which is an effective tool for conducting evaluation of future community health scenario, is scientifically reliable and exhibits a degree of systematization, innovation, operability and practical value. It is hoped to provide a reference to fomulate relevant policies and targeted improvement strategies.

Primary medical institutions, with the characteristics of comprehensive, continuous, coordinated, convenient and economical, play an important role in the diagnosis and treatment of common and frequently-occurring children's diseases, planned immunization and child health management, and lay a solid foundation for children's health services. It is essential to improve the quality of child health services for children under the management of family doctor contract. There are regional differences in the ability of children's health services at primary institutions in China. Therefore, accurate evaluation of the quality of children's health services at primary institutions is helpful to find problems in time and promote the development of children's health services at a higher level.

To assess the quality of community children's health services for contracted children, analyze the quality problems and optimization strategies, and provide international vision and decision-making reference for further improving the quality.

Taking a district of Chengdu as a typical case, three community health service centers with stronger child health service ability in the district were selected as the sample institutions, and the parents of children contracted by the sample institutions were surveyed with the online questionnaire on the quality of community child health service by using the Chinese version of primary care assessment tool (PCAT) .

Totally, 3 631 parents of contracted children were investigated. The total PCAT score of community child health service quality in the sample centers was (58.72 ± 13.43). The dimensions with relatively high PCAT scores of community child health service quality includes "continuity" "community first consultation (service availability and service use) " and "comprehensive service (service provision) ", while the dimensions "children and family-Centered" "comprehensive (available services) " and "coordination (referral) " had low scores.

It is suggested to strengthen the supply of diagnosis and treatment services for common pediatric diseases in the community, unblock the referral mechanism of Pediatrics, strengthen the awareness of parents of contracted children to be included in the contracted service team to participate in diagnosis and treatment decisions, and pay attention to the health services for children with non local registered residence.

Contracted family doctor services were implemented as a key action to reform primary care services in China. At present, the coverage of contracting has expanded stably. But the family doctor teams' evaluation of contracted family doctor services is not clear, which also highlights a number of issues that require further improvement in the provision of the services.

To study the contracted family doctor services for family doctor teams and associated factors.

In October 2022, a combination of purposive sampling and stratified cluster sampling was used for selecting family doctor team members from southern, central, northern and eastern Guangxi to participate in a questionnaire survey. The survey was conducted on the included subjects by using the provider version of the Primary Care Assessment Tools (PCAT-PS) , which contains 8 dimensions and 43 items. Multivariate Logistic regression analysis was used to research the influencing factors of family doctor teams' perception of PACT-PS of the services.

A total of 775 valid questionnaires were collected, with a valid response rate of 99.36%. The average score of the PCAT-PS of the family doctor team members was (32.55±3.90) . The dimensions with the relatively high score were family-centeredness and comprehensiveness, but the dimensions of first contact-access and ongoing care of the services had a relatively low-level perception. Multiple linear regression analysis showed that the type of organization, age, professional title, division of team responsibilities and working patterns were the factors that influence the PCAT-PS score of family doctor team members (P<0.05) .

The family doctor team members had an overall good evaluation on contracted family doctor services while differences in the quality of the services among primary health care institutions in urban and rural areas. The working mode of family doctor team has a positive effect on the improvement of contracted family doctor services quality. To further improve the family doctor teams' evaluation of contracted family doctor services, we need to accelerate the construction of family doctor teams with equal emphasis on "quality" and "quantity", explore the path of integrated salary and job development, and create a "government-community-family" shared governance and resource sharing network.

With the deepening of aging in China, there is an increasing demand for home care services for disabled elderly individuals. The evaluation of service quality provides an assurance for the implementation of high-quality services.

To develop a quality indicator system for the delivery of home care services to the disabled elderly population in Beijing based on the Delphi method, so as to offer objective criteria for evaluating the quality of home care services provided by community health service institutions.

Based on literature research and qualitative study, a preliminary pool of indicator system entries for the indicator system was formed, and an expert correspondence form was designed from March to May 2021. A total of 21 community nursing, general practice, and management research personnel experts with rich experience in the field of home medical services and elderly comprehensive assessment in Beijing were selected, and an expert correspondence form was sent to them by email from June to October 2021 to conduct three rounds of Delphi expert correspondence. The experts' personal information and authority were recorded and analyzed, to the establish a quality indicator system for home care services for disabled elderly individuals in Beijing.

All three rounds of expert correspondence form were returned and valid, with a 100.00% positive coefficient of experts from the 21 selected experts who had a mean expert authority score of 0.927 (ranging from 0.700 to 1.000), indicating an acceptable level of expertise. The first, second, and third rounds of expert correspondence yielded importance and feasibility coordination coefficients of 0.170 and 0.140 (P<0.001), 0.147 and 0.175 (P<0.001), 0.231 and 0.208 (P<0.001), respectively, indicating a high level of consensus among the experts and the reliability of the correspondence results. The resulting quality indicator system for home care services for disabled elderly individuals included three primary indicators of service conditions, service processes, and service outcomes, as well as nine secondary indicators and 34 tertiary indicators.

The indicator system constructed in this study is appropriate for evaluating the implementation quality of single visit medical service, and providing a reference for community health service institutions to formulate regulations and work programs.

Primary health care (PHC) is the bottom of the health care system, and its quality not only relates to the construction of hierarchical medical system, but also affects the health level of residents. Scientific and reasonable evaluation of PHC quality is the cornerstone of quality improvement, however, a unified and standardized quality evaluation system of PHC has not been developed in China. Therefore, the international quality evaluation tools of PHC are classified into four categories based on the evaluation focus: quality evaluation tools based on PHC connotations, quality evaluation tools emphasizing the functional characteristics of PHC, quality evaluation tools based on the perceptions of demand and/or supply side stakeholders, and other disease-specific tools or indicator systems. The content and characteristics of each tool were introduced and compared separately, their applicability and shortcomings were analyzed, and the evolution was reviewed, in order to provide reference for the construction of PHC quality evaluation tools in China.

In the context of the new round of medical and health system reform in China, it is of great significance to improve primary healthcare service system and continuously improve the capacity and quality of primary healthcare service. Under the guidance of empowerment theory, this study systematically summarizes relevant research literature, and the results indicated that full empowerment can be achieved through strengthening the guidance for primary health care, focusing on the maintenance of primary healthcare talents, adjusting the allocation mechanism of health resources, and improving the service quality evaluation system, which is conducive to the establishment of a comprehensive, continuously coordinated, fair and accessible integrated high-quality primary healthcare service system. This study further proposes strategies for continuous improvement and enhancement of primary healthcare service quality, aiming to provide reference and basis for solving the structural difficulties in improving the quality and capacity of primary healthcare services.

The concept of "patients-centered" has presented higher requirements doctor-patient communication and reconstructing doctor-patient relationship in public primary health care institutions.

To analyze the impact of "patients-centered" doctor-patient communication on the quality of primary care services, and provide scientific evidence to promote reforms in public primary health care institutions.

All public community health centers providing primary care services in the main urban area of a city in Inner Mongolia Autonomous Region were selected as the study sites to conduct a field survey in 2021 using the standardized patient method, which included 118 items of doctor-patient communication data involving 26 medical institutions, 59 doctors, and 12 standardized patients. Common cold, asthma, and unstable angina were selected as the types of diseases to be portrayed by the standardized patients in this study. A combination of multiple regression model and Probit model was used to evaluate the impact of "patients-centered" doctor-patient communication on the quality of primary care services.

Results obtained from the 118 items of doctor-patient communication data revealed that the median adherence rate for recommended consultation items was 17.6% (14.6%), and the median adherence rate for recommended examination items was 25.0% (40.0%), among them, 75 cases (63.6%) were correctly diagnosed, and 59 cases (50.0%) were correctly treated. The median total cost was 84.84 yuan (130.44 yuan), and the median drug cost was 37.62 yuan (47.38 yuan), among them, 66 (55.9%) involved unnecessary drugs, and 71 (60.2%) included unnecessary examinations. The median visit duration was 13.625 (10.850) min. The average score for "patients-centered" doctor-patient communication was (26.712±10.658), with the first dimension scoring (12.915±5.355) points, the second dimension scoring (7.492±2.867) points, and the third dimension scoring (6.305±3.465) points. The results of multiple linear regression model and Probit model indicated that for every one-point increase in the total score of patient-centered doctor-patient communication, the adherence rates for both recommended consultation items and recommended examinations items increased by 0.001 percentage points, the correct diagnosis rate increased by an average of 4.6 percentage points, the correct treatment rate increased by 4.2 percentage points, the total cost increased by 1.993 yuan, the drug cost increased by 0.517 yuan, the proportion of unnecessary drugs decreased by 3.4 percentage points, the proportion of unnecessary examinations increased by 0.2 percentage points, and the visit duration decreased by 0.291 minutes.

"Patients-centered" doctor-patient communication enhances the effectiveness and safety of medical services, while it also increases medical costs. It is necessary to promote "patients-centered" doctor-patient communication from the aspects of resource endowment, salary incentives, doctor-patient relationships, and collaborative services, thereby improving the quality of primary care services.

Currently, scholars in China are exploring chronic disease management models based on treatment-prevention integration, however, the quantitative evaluation researches are scarce and in the initial stage, lacking in relevance and timeliness.

To construct the on-site evaluation index system for integration of medical and preventive services for chronic diseases in primary health care institutions and provide a reference for the quality improvement of integration of medical and preventive services.

The on-site evaluation index system for integration of medical and preventive services for chronic diseases in primary health care institutions was initially constructed by literature review, policy induction and expert interview. From June to August 2022, two rounds of expert consultation with 17 experts were conducted using the Delphi method, the index system was determined according to the results of expert consultation, and the weight of each index was calculated by using the analytic hierarchy process.

The on-site evaluation index system for integration of medical and preventive services for chronic diseases in primary health care institutions was initially constructed consisting of 5 primary indexes, 12 secondary indexes and 37 tertiary indexes. The effective questionnaire recovery rate of the two rounds of expert consultation was 100.0% with the expert authority coefficient of 0.81; the Kendall coordination coefficients of the importance of the three levels of indexes were 0.239 (χ²=8.76, P<0.05) and 0.275 (χ²=4.15, P<0.05) , the Kendall coordination coefficients of the feasibility of the three levels of indexes were 0.234 (χ²=19.63, P<0.05) and 0.248 (χ²=12.43, P<0.05) . The on-site evaluation index system for integration of medical and preventive services for chronic diseases in primary health care institutions was finally constructed consisting of 5 primary indexes, 12 secondary indexes and 40 tertiary indexes, the weight of the five primary indicators was 0.200 0.

The evaluation index system has a certain practical guidance for the improvement of the capacity of integration of medical and preventive services for chronic diseases in urban and rural community health service institutions. However, the evaluation index system should also be dynamically adjusted according to the specific situation to effectively reflect the quality of integration of medical and preventive services for chronic diseases in primary health care institutions.

The number of migrant population in China remains high, primarily driven by the developments in industrialisation and urbanisation. The health status and healthcare-seeking experience of this group has become a hot social issue, and promoting their access to equitable essential healthcare services is an important part of China's healthcare system reform.

To compare the experience of using essential medical services between migrant and permanent populations in Guangzhou, to provide evidence for improving the level of using essential medical services in migrant population and for promoting the healthcare equity.

From September to November 2019, we used a multistage random sampling method to select 1 568 cases (including migrant and permanent residents) treated by six general practitioner teams from six community health centers in Guangzhou. Their demographics and experiences of using essential medical services were collected by a questionnaire survey using a self-developed General Data Questionnaire and the simplified Primary Care Assessment Tool-Adult Edition (PCAT-AE) . We compared the total score of the PCAT-AE and its domains scores between the two groups. We used the generalized linear model to analyze the association between the residency status and the experience of using essential medical services.

Altogether, 1 568 cases who handed in responsive questionnaires were included for final analysis, among whom 186 (11.86%) were migrant residents. The average total score of the PCAT-AE of all participants, permanent and migrant cases was 3.19 (1.22) , 3.24 (1.23) , and 2.93 (0.75) , respectively. Compared with the permanent residents, the migrants showed lower total score and dimension scores of the PCAT-AE (P<0.05) . The results of the generalized linear model demonstrated that compared with the permanent residents, migrants had worse experience in using services〔b (95%CI) =-0.128 (-0.218, -0.037) , P=0.006〕, such as the use of first-contact care〔b (95%CI) =-0.245 (-0.341, -0.148) , P<0.001〕, continuing care〔b (95%CI) =-0.175 (-0.292, -0.059) , P=0.003〕, family-centered care〔b (95%CI) =-0.112 (-0.225, 0.001) , P=0.050〕, community-oriented care〔b (95%CI) =-0.176 (-0.286, -0.066) , P=0.002〕, and culturally competent care〔b (95%CI) =-0.270 (-0.383, -0.156) , P<0.001〕.

The migrants had worse experience of using essential medical services than the permanent residents. In view of this, it is recommended for primary healthcare institutions to provide continuous, accessible, and comprehensive life-cycle essential healthcare services for migrants according to their characteristics, so as to promote the quality development of community health services.

Since the number of chronic disease patients is increasing, relevant prevention and treatment services have become important long-term tasks for primary care institutions. However, problems in the provision of primary care services seriously affect the perception of such services in residents, especially chronic disease patients.

To understand chronic disease patients' assessment of the quality of primary care services, providing evidence for improving the quality of chronic disease management services in primary care.

A survey was conducted between July and August, 2020 with chronic disease patients (n=630) selected from primary care settings in Guangdong's Chaozhou by use of multistage stratified random sampling. The Primary Care Assessment Tool-Adult Simplified Version (PCAT-AS) (consists of 10 domains, including first contact accessibility, coordination, ongoing, comprehensiveness, community orientation and other 5 domains) was used in the survey for understanding chronic disease patients' assessment of the quality of primary care services. Multiple linear regression was adopted to identify factors potentially associated with the PCAT-AS score.

Altogether, 553 cases (87.8%) who returned responsive questionnaires were enrolled for analysis. The average total PCAT-AS score for all respondents was (95.88±13.44) . The top three domains ranked in terms of average standardized score were comprehensiveness (services needed) (7.89) , first contact accessibility (7.72) , and first contact utilization (7.58) , and the bottom three-ranked domains were coordination (referrals) (5.61) , community orientation (6.11) and patient and family centeredness (6.40) . Multiple linear regression analysis indicated that higher total PCAT-AS score was associated with living in urban areas in contrast to rural areas〔b (95%CI) =-6.983 (-10.598, -3.368) 〕, senior high school and higher education level instead of junior high school and lower education level〔b (95%CI) =4.046 (0.966, 7.125) 〕, permanent residents without the local hukou in contrast to those with local hukou〔b (95%CI) =-5.360 (-9.517, -1.202) 〕, good self-rated health instead of relatively poor self-rated health〔b (95%CI) =-4.962 (-8.438, -1.486) 〕 or poor self-rated health〔b (95%CI) =-7.787 (-12.789, -2.786) 〕, having a contracted family doctor instead of having no contracted family doctor〔b (95%CI) =4.686 (2.508, 6.865) 〕, first choosing a community health center for treating common diseases instead of a village clinic〔b (95%CI) =-5.865 (-9.951, -1.779) 〕 or a district/county-level hospital or tertiary hospital〔b (95%CI) =-6.061 (-11.330, -0.792) 〕, 4-6 primary care visits instead of 1-3 primary care visits〔b (95%CI) =5.876 (3.367, 8.384) or 7 or more primary care visits instead of 1-3 primary care visits〔b (95%CI) =9.045 (6.512, 11.579) 〕, and high satisfaction with primary care services instead of fair satisfaction〔b (95%CI) =-2.844 (-4.817, -0.870) 〕 or dissatisfaction〔b (95%CI) =-10.418 (-17.050, -3.786) 〕.

Overall, Chaozhou chronic disease patients reported a sound level of treatment experience in primary care. Specifically, they reported good primary care experience in three domains, including comprehensiveness, first contact accessibility and first contact utilization, but poor experience in community orientation, and coordination (including information systems and referrals) . However, urban patients reported better primary care experience than rural patients. So continued efforts are needed to strengthen primary care performance in rural areas.