Abstract: Background　Promoting the contracted family doctor services plays a key role in the development of hierarchical medical system and is an important measure for deepening the reform of the pharmaceutical and healthcare system.However，despite incentive effects of various policies，and the vigorous promotion and delivery of the contracted family doctor services by community health centers，residents' rate of signing a health service contract with the family doctor is less than 30%，and the utilization rate of family doctor services is still quite low.Identifying the determinants for community residents' decisions to contract for such services is of great significance in improving the contracting rate，and enhancing the quality level of such services.Objective　To examine the correlations of community residents' decisions to contract for family doctor services with influencing factors，to provide recommendations for improving the contracted family doctor services.Methods　This questionnaire survey was carried out in a convenience sample of 201 contracted and uncontracted residents from the service areas of Pudong New Area Tangqiao Community Health Center（PNATCHC），Shanghai，from May 4th to May 25th 2018.The questionnaire used included sociodemographic characteristics，comprehensive evaluation of PNATCHC，intention to contract and the utilization of contracted services.We did the analyses with the level of intention to contract and utilization of the contracted services among the residents with different sociodemographic characteristics and evaluation scores of PNATCHC.Wilcoxon rank-sum test or Kruskal-Wallis H test was used to compare the unordered categorical independent variables，and Spearman's correlation analyses were performed with ordered categorical or quantitative independent variables.Results　The retirees showed higher rates of contracting and utilizing the contracted services compared with others （P<0.05）.Those with an experience of contracting were more prone to contract，and they showed higher rates of contracting and utilizing the contracted services compared with those without （P<0.05）.Spearman's correlation analysis revealed that the level of intention to contract increased with the evaluation scores for PNATCHC（P<0.05）.And the utilization of the contracted services increased with the resident's age and the evaluation scores for PNATCHC，but decreased with personal monthly income（P<0.05）.Conclusion　In order to improve the quality of contracted family doctor services，and enrich the contents of health management，priorities should be given to enhance the capabilities and maintain a good image of community family doctors，and publicize the contracted family doctor services and the role of family doctors in delivering such services.Moreover，it is suggested that the service coverage should be enlarged in young，employed and high-income groups.

Key words:
Contracted services of family doctors, Contract-signing behavior, Contract-signing decision, Service utilization, Residents, Root cause analysis

摘要： 背景　推进家庭医生签约服务是建立分级诊疗制度的关键，也是深化医药卫生体制改革的重要任务。然而，尽管在各种政策指导下，各社区卫生服务中心大力推行和做实家庭医生签约服务，社区居民的签约率仍不到30%，家庭医生的服务利用率仍较低。明确社区居民的签约决策受到哪些因素影响，对提高社区居民家庭医生签约率、进一步优化社区居民家庭医生签约服务具有重要意义。目的　对社区居民签约决策与影响因素之间的关系进行验证，为进一步优化社区居民家庭医生签约服务提供建议。方法　于2018-05-04至2018-05-25，采用方便抽样法，对上海市浦东新区塘桥社区卫生服务中心辖区签约和未签约居民共201例进行问卷调查，问卷内容包括社会人口学特征、对社区卫生服务中心的评价、签约倾向及签约服务利用情况。对不同社会人口学特征及对社区卫生服务中心的评价居民的签约倾向、签约服务利用情况进行分析，无序分类变量组间比较采用秩和检验，有序分类变量或定量变量采用Spearman秩相关分析。结果　退休/离休居民更多地选择签约并利用家庭医生服务，差异有统计学意义（P<0.05）；与没有签约经历的居民相比，有过签约经历的居民更有意愿与家庭医生签约，且更多地选择签约并利用家庭医生服务，差异有统计学意义（P<0.05）。Spearman秩相关分析显示，签约倾向与居民对社区卫生服务中心的评价呈正相关（P<0.05）；签约服务利用情况与年龄及居民对社区卫生服务中心的评价呈正相关（P<0.05），与个人月收入呈负相关（P<0.05）。结论　社区卫生服务中心应优先从注重家庭医生能力提升、维护家庭医生形象、做好家庭医生及签约服务内容宣传工作、保障对社区就诊居民的服务质量、丰富健康管理的服务内容等方面做出改进；此外，家庭医生签约人群覆盖范围有待向年轻、在职、高收入群体扩展。

关键词: 家庭医生签约服务, 签约行为, 签约决策, 服务利用, 居民, 影响因素分析