目的: 分析分级诊疗面临的深层障碍,探究智慧医疗破解这一难题的内在机理,并构建可操作的实现路径。方法: 以成都市为样本,超越“技术工具论”的既有视角,运用扎根理论方法对基层医疗机构核心管理者进行深度访谈,系统诊断分级诊疗面临的深层障碍,并探究智慧医疗破解难题的内在逻辑。结果: 成都市分级诊疗面临由宏观制度失灵、微观动机扭曲、协同流程中断与技术应用困境构成的系统性困局;智慧医疗的破局之道在于遵循资源整合、协同合作、风险控制与数据赋能四大内在逻辑,分别对应重构时空效率、重塑激励信任、明确权责追溯与驱动循证决策。结论: 结合成都实际,应从顶层设计优化、激励机制再造、协同流程保障及数据治理深化四个维度,构建技术—制度双轮驱动的新型分级诊疗生态,为全国智慧医疗驱动分级诊疗高质量落地提供实践参考。

Objective: The paper analyzes the deep-seated obstacles faced by hierarchical diagnosis and treatment, explores the internal mechanism by which smart healthcare addresses this challenge, and constructs an operable implementation path. Methods: Using Chengdu City as a sample and moving beyond the existing "technology tool theory" perspective, the grounded theory method was applied to conduct in-depth interviews with key managers of primary healthcare institutions to systematically diagnose the deep-seated obstacles in hierarchical diagnosis and treatment, and explore the internal logic through which smart healthcare solves these problems. Results: Hierarchical diagnosis and treatment in Chengdu City faces a systemic dilemma composed of macro-level institutional failure, micro-level motivational distortion, interrupted collaborative processes, and difficulties in technology application; the breakthrough path of smart healthcare lies in following four internal logics: resource integration, collaborative cooperation, risk control, and data empowerment, which correspond respectively to restructuring spatiotemporal efficiency, reshaping incentive trust, clarifying responsibility and traceability, and driving evidence-based decision-making. Conclusion: Considering the current situation in Chengdu City, efforts should be made in four dimensions—top-level design optimization, incentive mechanism reconstruction, collaborative process assurance, and data governance deepening—to construct a new hierarchical diagnosis and treatment ecosystem driven by both technology and institutional mechanisms, providing practical references for the high-quality implementation of hierarchical diagnosis and treatment driven by smart healthcare nationwide.