关键词: 社区卫生服务中心, 就诊人群, 空间分布, 天津市

Abstract: Residents' demand for primary health services has increased significantly in response to the intensifying aging population situation in China. To optimize the layout of community health centers and provide primary medical care services in better accordance with residents' needs, this study uses buffer zone analysis, the Pearson correlation analysis, and the structural equation model (SEM) to analyze the spatial distribution characteristics and influencing factors of treatment groups in 102 community health centers in the main urban area of Tianjin.
　　According to the results, the spatial coverage rate of community health centers in urban Tianjin decreases gradually from the center to the suburbs. Different from the coverage rate distribution, there are moderate distributions of treatment groups in the urban center (Heping District), high distribution in districts surrounding the center (Hexi, Nankai, Hedong, Hebei, and Hongqiao), and a spatial distribution pattern of "middle-high-low" in four districts surrounding the city (Beichen, Xiqing, Jinnan, and Dongli).  The density of the residential neighborhood within 1000-meter service coverage of community health service centers, road network density, number of bus stops, population density in blocks, aging level, number of medical workers, equipment level, and building area in community health service centers have significantly positive correlations with the number of outpatient visits. According to SEM's "influencing mechanism of the spatial distribution of treatment groups" in community health service centers, social factors influence the number of outpatient visits in community health service centers more than resource allocation or spatial elements. The standardized path coefficient of the social element is 0.888. Specifically, the aging level of blocks is the most important influencing factor, with a factor load of 0.542. The standardized path coefficient of the resource allocation element is 0.343. The number of medical workers is the most important influencing factor, with a factor load of 0.868. The standardized path coefficient of spatial elements is 0.305. The number of bus stops is the most important influencing factor, with a factor load of 0.877.
　　The following planning strategies are proposed, based on the analysis, to strengthen the construction of community health centers and meet the daily medical service needs of residents. Firstly, consideration should be given to the aging level and population density in blocks when planning the layout of community health centers. The following is recommended: optimize the spatial distribution density of community health centers appropriately, allocate medical resources reasonably, and realize the effective supply of the medical service needs of residents in the blocks. Secondly, the medical resources of community health centers should be allocated according to age structure and the practical needs of residents in the blocks. Internal medical facilities should be distributed reasonably. Finally, spatial accessibility factors like bus stop numbers, road network density, and quantity of residential communities should be optimized while planning the layout of community health service centers. 
　　This study determines the spatial distribution layout of treatment groups in community health centers and its influencing factors, including exploring the influencing paths of spatial, social, and resource allocation elements on the number of outpatient visits in community health centers. The research results can provide theoretical references to optimize the spatial layout and resource allocation of community health centers and guide research on the planning of other public service facilities.

Key words: community health service center, treatment groups, spatial distribution, Tianjin