Background Digital health services (DHS) are pivotal to China's digital health transformation for optimizing medical resource allocation. Elderly inpatients are hindered by the digital divide and technology acceptance barriers in using DHS. This study aims to explore the usage and influencing factors informational, intermediary, and diagnostic DHS across awareness, want, and adoption stages, providing evidence for policy formulation. Methods This multicenter cross-sectional study enrolled 451 inpatients aged ≥60 years from three hospitals in Jinan, China. Building on a modified Technology Acceptance Model (TAM) framework with core constructs including Perceived Usefulness (PU), Perceived Ease of Use (PEOU), and Usage Behavior (UB), we extended the model to incorporate health status (EuroQol Five Dimensions Questionnaire, EQ-5D), eHealth literacy (The eHealth Literacy Scale, eHEALS), and demographics (age, residence location, education duration). Matrix analysis and Structural Equation Modeling (SEM) analyzed variable interaction pathways to evaluate their comprehensive impact on DHS utilization behaviors among elderly inpatients. Results Matrix analysis demonstrated higher acceptance of intermediary DHS with minor disparities, while diagnostic DHS had lower acceptance and significant gaps. Advanced age and female gender were linked to lower acceptance across all DHS categories. SEM analysis revealed that PU (β=0.047, P=0.009), education duration (β=0.015, P<0.001), EQ-5D (β=0.056, P<0.001), and eHEALS (β=0.065, P<0.001) exerted significant positive effects on patients' DHS adoption. Conversely, age (β=−0.006, P<0.001), rural residence (β=−0.075, P=0.006), and compliance (β=−0.088, P<0.001) demonstrated significant direct negative effects on such behaviors. Conclusions This study established an extended TAM framework, identifying key determinants, such as eHealth literacy, health status, PU, age, and residence location, that influence DHS utilization among elderly inpatients through matrix analysis and SEM. These findings offer robust scientific support for policymaking to improve DHS accessibility and usage rate within this population in China.

Digital Health Services, Elderly Inpatients, Technology Acceptance Model, eHEALS, EQ-5D, Matrix Analysis, Structural Equation Model