Introduction: As foundational units of China's three-tiered medical care system, primary healthcare institutions are crucial for the effectiveness of the tiered healthcare delivery system. Outpatient and emergency services, characterized by high patient volumes and complex scenarios, are fundamental to patient safety and public trust in primary care. Assessing and improving their quality is therefore of paramount importance. Aim: This study aimed to assess the current quality status and explore the influencing factors of outpatient and emergency care in primary healthcare institutions in Jiangsu Province, China, based on the Donabedian structure-process-outcome model. Materials and Methods: A prospective, observational study was conducted in 62 primary healthcare institutions across 13 prefecture-level cities in Jiangsu Province between January and December 2024. Three core quality control indicators were investigated: Average Daily Patient Visits per Physician, Standardization Rate of Emergency Rescue Procedures, and Timeliness Rate of Critical Value Management. Data were sourced from a provincial quality control platform. Univariate analysis (Mann-Whitney U, Spearman, Chi-square tests) and multivariable analysis (multiple linear regression, binary logistic regression) were employed to identify factors associated with the quality indicators. Results: Significant disparities were observed among institutions. The median average daily patient visits per physician was 22.1, with 12.9% of institutions indicating overload (>30 visits). The median score for emergency rescue procedure standardization was 27.9 points, with 48.4% meeting the high-quality standard (≥28.0 points). The timeliness rate of critical value management was 100% in 82.3% of institutions, while 17.7% had delays. Multivariable analysis revealed that: Average Daily Patient Visits per Physician was negatively associated with the total number of physicians (β = -0.115, P < 0.001) but positively associated with the number of specialized departments (β = 0.422, P < 0.001). The Standardization Rate of Emergency Rescue Procedures was positively influenced by the proportion of technicians with an associate degree or higher (β = 0.371, P = 0.001) and the total number of physicians (β = 0.268, P = 0.039). The Timeliness Rate of Critical Value Management was significantly improved by a higher proportion of highly educated staff (OR = 1.082, P = 0.040) and a greater proportion of intermediate/senior technical personnel (OR = 1.054, P = 0.049). Discussion and Conclusion: The quality of outpatient and emergency care in primary institutions is heterogeneous and significantly influenced by human resource allocation and specialized department development. Optimizing the physician workforce structure, increasing the proportion of high-level personnel, and promoting appropriate specialized department development are key pathways to improving service efficiency and quality. Recommendations include adopting a "general-specialty integrated" model and incorporating these quality indicators into performance evaluations. These findings provide empirical evidence for enhancing primary care quality, though further multi-province validation is warranted.
Xiaolong et al. (Sat,) studied this question.