A cross-sectional study on patient-centered outpatient service quality in the county-level integrated health organization of Yuhuan, Zhejiang province of China.

Purpose: This study aims to investigate the outpatient service quality of the Yuhuan CIHO and the interrelationships among patient expectations, perceived service quality, satisfaction, and behavioral intentions. Patients and methods: Data were analyzed using descriptive statistics, non-parametric tests, Wilcoxon signed-rank test, and multiple regression analysis to assess the status and influencing factors of outpatient service quality. Structural equation modeling (SEM) was applied to test the hypothesized relationships among expectations, perceptions, satisfaction, and behavioral intentions. Results: Patients' socio-demographic characteristics and healthcare utilization patterns significantly influenced their expectations and perceptions of service quality. Overall, the service environment, facilities, and professional competence in the Yuhuan Health Community met or exceeded patient expectations. However, gaps between expectation and perception persisted in responsiveness and assurance at county-level hospitals, and in reliability at certain primary care institutions. SEM results revealed that while patient expectations did not directly influence satisfaction, they exerted a strong positive effect on perceived service quality ( Conclusion: From a patient-centered perspective, health community development should prioritize reducing inter-institutional disparities in service delivery, actively manage patient expectations, and deliver personalized outpatient services. Furthermore, leveraging digital health platforms to strengthen vertical integration between county hospitals and primary care units is essential. Standardized protocols and proactive expectation management mechanisms should be established for critical dimensions such as responsiveness, assurance, and reliability to systematically enhance outpatient service quality.