Abstract: Objective To analyze the tendency of diabetes mellitus patients in choosing the first-contact medical institution and reason for referral and to provide evidences for hierarchical medical service implementation. Methods We compared the seeking tendency and referral reasons between the two groups of diabetes mellitus patients, including signed group and ambulatory group, in the suburban community of Shanghai Pudong District. Descriptive statistical methods, χ² test, constituent ratio, and percentage were applied to analyze the quantitative data. Thematic frame analysis and SWOT method were adopted to analyze the qualitative data. Results We enrolled 496 diabetes mellitus patients in the signed group, and 464 patients in the ambulatory group. The tendencies between two groups of patients in choosing the first-contact medical institution showed no statistical significance (P>0.05). The reasons for referral included medical technical level, drug or laboratory test deficiency, travel distance to facility, medical service quality, further examinations, and other reasons. Comparing the two groups, there were statistically significant difference among medical service quality and other reasons(P<0.05 or P<0.001, respectively). Conclusion The results revealed that the contracted mode is more effective and sustainable to manage and serve the patients. Equipping the ancillary departments, sharing the pharmacy information and laboratory results, three-level linkage, and government support are key points to improve the ability of first-contact and continual treatment of the community hospitals and to implement the hierarchal medical service.