To analyze the influencing factors and various combination types of local government's practice innovation toward county medical community.

In March 2021, the preliminary results of the 2nd "Searching for Value Cases of County Medical Community Practice" held by the County Medical Community Branch of the China Hospital Association was used as the source of cases; The "type of policy innovation" was used as the outcome variable ("central dominative innovation"/"local responsive innovation"=0; "local autonomous innovation"=1) ; The level of economic development, administrative level, geographical location, problem attributes, and platform were used as condition variables; The crisp set qualitative comparative analysis (csQCA) was used to explore the factors influencing the county medical community innovation by local government, in order to constructthe path models of innovation practice through necessary condition analysis and conditional combination analysis.

The consistency of all five conditional variables was<0.9, which meant that the level of economic development, administrative level, geographical location, problem attributes, and platform were not necessary conditions for autonomous innovation. The results of conditional combination analysis (based on intermediate solution) showed that a total of five sets of sufficient conditions were obtained, including "the level of economic development and non-geographical location and platform" "administrative level and non-geographical location and platform" "the level of economic development and problem attributes and platform" "non- the level of economic development and geographical location and non-problem attributes and platform" "the level of economic development and administrative level and geographical location and problem attributes", separately. All five groups had a sufficient condition consistency index of 1, original coverage of 0.14-0.43, net coverage of 0.14-0.43, and overall coverage of 1. The innovation practice of local government's medical community practice mainly presents two types of models, namely platform innovation model and motivational innovation model.

If local governments want to achieve high-level medical community innovation practice, they should pay attention to the strong correlation between policies and local economic development levels, activate local governments' willingness to innovate actively, and strengthen platform support for county medical communities. This study provided a special reference significance for understanding the practice innovation mechanism of county medical community.

探究影响地方政府县域医共体创新实践的因素，并分析其组合路径。

于2021年3月，以中国医院协会医共体分会举办的第二届"寻找县域医共体实践价值案例"评选活动的初选结果为案例源，将"政策创新类型"作为结果变量（中央主导型创新/地方回应型创新=0，地方自发型创新=1），以经济发展水平、行政层级、地理区位、问题属性及平台作为条件变量，采用清晰集定性比较分析（csQCA）法，通过必要条件分析、充分条件组合分析，探究影响地方政府县域医共体创新实践的因素并构建地方政府县域医共体创新实践的影响路径模型。

5个条件变量一致性均<0.9，即经济发展水平、行政层级、地理区位、问题属性及平台均不是地方自发型创新的必要条件。条件变量组合分析（基于中间解）结果显示，共得到5组前因条件组合，分别为：经济发展水平*~地理区位*平台，行政层级*~地理区位*平台，经济发展水平*问题属性*平台，~经济发展水平*地理区位*~问题属性*平台，经济发展水平*行政层级*地理区位*问题属性（*表示"且"，~表示"非"）。5组前因条件组合一致性指标均为1，原始覆盖率为0.14~0.43，净覆盖率为0.14~0.43，总体覆盖率为1。地方政府县域医共体创新实践主要呈现出两类模式，即平台型创新模式和动机型创新模式。

若要实现高水平的医共体创新实践，应该关注政策与当地经济发展水平之间的强相关性，激活地方政府的主动创新意愿，以及加强对县域医共体的平台支持。本研究对于理解地方政府县域医共体创新实践的机理乃至地方政府创新都具有一定价值。