中文摘要：

目的分析居民参与分级诊疗意愿与首诊医院选择意向情况。方法采用问卷调查法，对山东省3市1500户居民进行人户调查，将知晓分级诊疗制度的773名居民纳入研究样本。运用描述性分析、多因素logistic回归模型，对居民意愿进行统计学分析。结果85．0％的居民表示愿意参与分级诊疗。自感病轻时，55．0％的居民更愿意选择基层医疗机构首诊，且农村居民（58．9％）高于城市居民（48．0％），差异有统计学意义（P〈0．01）；自感病重时，87．3％的居民更倾向选择县级及以上医疗机构首诊，城市居民（94．3％）高于农村居民（83．3％），差异有统计学意义（P〈0．01）。医疗机构服务能力与居民就医理念在患者首诊医院选择意向中发挥着关键作用。结论提升基层医疗机构服务能力、改善居民不合理就医用药理念，是保障分级诊疗制度实施效果的关键。

英文摘要：

Objective To analyze the residents＇ willingness to hierarchical medical system and their intention of first visit hospitals. Methods Customized questionnaire was used for in-home survey of 1 500 households in three cities of Shandong province, with 773 of the residents aware of hierarchical medical system used as the study samples. Descriptive analysis and multi factor Logistic regression were employed for statistical analysis of their intention. Results 85.0% the residents expressed willingness to embrace hierarchical medical system. 55.0% of the residents prefer primary medical institutions as their first visit in case of mild illness, a choice chosen by more rural residents （ 58.9% ） than urban residents （ 48.0% ）, a difference of statistical significance（P 〈 0. 01 ）. In the case of severe illness, 87. 3% of them prefer major hospitals as their first visit, and more urban residents （94. 3% ）take this option than the rural residents （83.3%） ,a difference of statistical significance （ P 〈 0.01 ）. Service ability of medical institutions and residents＇ concept for medical service played a key role in their choice of first visit hospitals. Conclusions The key to ensuring the implementation effect of hierarchical medical system lies in better service ability of primary medical institutions and correction of residents＇ irrational medication concepts.