Abstract: Background　The deployment of hierarchical diagnosis and treatment policy has been comprehensively promoted by Henan provincial government.The level that hierarchical diagnosis and treatment policy implemented will directly determine the effect of the new healthcare reform.Precise understanding of the current status of residents' cognition of hierarchical medical system will be helpful in the promotion of the policy.Objective　To have a great understanding on the cognition level of residents for hierarchical medical system and to further explore its influencing factors in Henan Province.Methods According to researchers' family location，residents who were 16 years old or older with good communication levels and were willing to cooperate with the survey were selected as the respondents in 14 prefecture-level cities from Henan Province using convenient sampling method.A self-designed questionnaire was used to conduct the survey from November 2017 to March 2018.The main contents of the questionnaire were basic information of residents，residents' cognition to hierarchical medical system，suggestions on the implementation of the hierarchical medical system，and access to medical policy information.A total of 1 200 questionnaires were distributed and 1 137 valid questionnaires were returned with an effective recovery rate of 94.75%.Results　As for the hierarchical medical system，among 1 137 valid questionnaires，41（3.61%）residents chose "strong understanding"；141（12.40%）residents chose "clear understanding"；181（15.92%）residents chose "understanding"；542（47.67%）residents chose "little understanding"；232 （20.40%） residents chose "never heard of".The difference in the orthogonal comparison of diverse educational levels，types of registered permanent residence，and health care types among residents with different cognition levels of hierarchical medical system was statistically significant（P<0.05）．The results of binary Logistic regression analysis showed that the educational level and health care type were relevant factors affecting residents' cognition of hierarchical medical system（P<0.05）．The main ways for residents to gain medical policy information were broadcasting and television （59.19%，673/1 137）．Conclusion　Residents in Henan Province have insufficient understanding of the hierarchical medical system.It is proposed to further reinforce the promotion of hierarchical medical system and carry out personalized propaganda for residents in different situations ，so as to achieve the maximum publicity effect．

Key words: Hierarchical medical system, Cognition, Root cause analysis, Residents, Henan

摘要： 背景　河南省政府已在本省内对全面推动分级诊疗政策做出部署，分级诊疗政策的落实水平将直接决定新医改的效果，准确了解当前居民对分级诊疗制度的认知现状将有助于政策的推进。目的　了解河南省居民对分级诊疗制度的认知度，并进一步探索居民分级诊疗制度认知度的影响因素。方法　采用方便抽样法，根据调查员家庭所在地，以河南省14个地级市的管辖地区为调查地，选择≥16岁、交流水平良好并愿意配合调查的居民为调查对象。于2017年11月—2018年3月，采用自行设计的调查问卷进行调查。问卷主要内容有：居民基本情况，居民对分级诊疗制度的认知度，关于分级诊疗制度实施的建议，获取医疗政策信息的途径。共发放问卷1 200份，回收有效问卷1 137份，有效回收率为94.75%。结果　对于分级诊疗制度，1 137例居民中，41例（3.61%）选择“很了解”，141例（12.40%）选择“比较了解”，181例（15.92%）选择“一般了解”，542例（47.67%）选择“很少了解”，232例（20.40%）选择“没听说过”。其中不同文化程度、户口类型、医保类型居民分级诊疗制度认知度比较，差异有统计学意义（P<0.05）；多因素Logistic回归分析结果显示，文化程度和医保类型是居民对分级诊疗制度了解程度的影响因素（P<0.05）。居民获取医疗政策信息的途径主要为广播电视（59.19%，673/1 137）。结论　河南省居民对于分级诊疗制度的认识不足。建议进一步加强分级诊疗政策的宣传，可针对不同情况居民进行个性化宣传，以达到最大宣传效果。

关键词: 分级诊疗, 认知, 影响因素分析, 居民, 河南