Abstract: Objective To investigate the implementation of the "1+1+1" medical institution combination signing project in Shanghai community, and to explore the willingness of community residents and its influencing factors, so as to promote the medical contract signing and improve the hierarchical medical care system in Shanghai. Methods A convenience sampling method was used to select residents from 6 community health centers in three different districts in Shanghai. A total of 1 800 people were surveyed, and 1 720 valid questionnaires were collected. SPSS 20.0 software was used to carry out Chi-square test and Logistic regression analysis. Results The rates of medical contract signing among community residents was 79.1%. Multivariate logistic regression analysis revealed that the residents with good cognition on the"1+1+1" project, high reliance on community health service center, low level of education or chronic administration preferred the medical contract signing. Conclusion At present, the "1+1+1" medical institution combination signing project is in good state of implementation, and the signing rate in the community is relatively high. To further promote the project need to continue to strengthen propaganda, enhance the awareness of residents for contracted projects; improve the service level of community health service center, enhance the trust of the residents of the community health service center, and enhance further implement and policies related to dispensation and transfer treatment in the signing system, so as to attract residents to sign contracts, and provide a good platform for subsequent development of the hierarchical medical care system.