diff --git a/crates/erp-health/src/service/ai_action_dispatcher.rs b/crates/erp-health/src/service/ai_action_dispatcher.rs
new file mode 100644
index 0000000..db1950b
--- /dev/null
+++ b/crates/erp-health/src/service/ai_action_dispatcher.rs
@@ -0,0 +1,185 @@
+use std::time::Duration;
+
+use erp_core::events::EventBus;
+use sea_orm::DatabaseConnection;
+use uuid::Uuid;
+
+/// 执行模式
+#[derive(Debug, Clone, PartialEq, Eq)]
+pub enum ExecutionMode {
+    AutoExecute,
+    DoctorReview,
+    UrgentConfirm,
+}
+
+/// 分发决策
+#[derive(Debug, Clone)]
+pub struct DispatchDecision {
+    pub execution_mode: ExecutionMode,
+    pub response_timeout: Option<Duration>,
+}
+
+/// 根据风险等级和建议类型生成执行决策
+pub fn dispatch_decision(risk_level: &str, _suggestion_type: &str) -> DispatchDecision {
+    match risk_level {
+        "low" => DispatchDecision {
+            execution_mode: ExecutionMode::AutoExecute,
+            response_timeout: None,
+        },
+        "medium" => DispatchDecision {
+            execution_mode: ExecutionMode::DoctorReview,
+            response_timeout: Some(Duration::from_secs(86400)),
+        },
+        "high" => DispatchDecision {
+            execution_mode: ExecutionMode::UrgentConfirm,
+            response_timeout: Some(Duration::from_secs(14400)),
+        },
+        _ => DispatchDecision {
+            execution_mode: ExecutionMode::DoctorReview,
+            response_timeout: Some(Duration::from_secs(86400)),
+        },
+    }
+}
+
+/// 处理 AI 建议事件：根据风险等级分发到不同执行路径
+pub async fn handle_ai_suggestions(
+    db: &DatabaseConnection,
+    event_bus: &EventBus,
+    tenant_id: Uuid,
+    _analysis_id: Uuid,
+    patient_id: Uuid,
+    doctor_id: Option<Uuid>,
+    suggestions: &[serde_json::Value],
+    risk_level: &str,
+) {
+    for suggestion in suggestions {
+        let suggestion_type = suggestion["type"].as_str().unwrap_or("alert");
+        let decision = dispatch_decision(risk_level, suggestion_type);
+
+        match decision.execution_mode {
+            ExecutionMode::AutoExecute => {
+                execute_action(
+                    db,
+                    event_bus,
+                    tenant_id,
+                    patient_id,
+                    suggestion_type,
+                    suggestion,
+                )
+                .await;
+            }
+            ExecutionMode::DoctorReview | ExecutionMode::UrgentConfirm => {
+                create_pending_action(
+                    db,
+                    event_bus,
+                    tenant_id,
+                    patient_id,
+                    doctor_id,
+                    suggestion_type,
+                    suggestion,
+                    risk_level,
+                    &decision,
+                )
+                .await;
+            }
+        }
+    }
+}
+
+async fn execute_action(
+    db: &DatabaseConnection,
+    event_bus: &EventBus,
+    tenant_id: Uuid,
+    patient_id: Uuid,
+    action_type: &str,
+    params: &serde_json::Value,
+) {
+    match action_type {
+        "alert" => {
+            let event = erp_core::events::DomainEvent::new(
+                "health.ai_alert.sent",
+                tenant_id,
+                erp_core::events::build_event_payload(serde_json::json!({
+                    "patient_id": patient_id,
+                    "alert_type": "ai_risk_warning",
+                    "severity": params.get("severity").and_then(|v| v.as_str()).unwrap_or("warning"),
+                    "message": params.get("message").and_then(|v| v.as_str()).unwrap_or(""),
+                    "source": "ai_analysis",
+                })),
+            );
+            event_bus.publish(event, db).await;
+        }
+        "followup" | "appointment" => {
+            let event = erp_core::events::DomainEvent::new(
+                "health.ai_action.auto_executed",
+                tenant_id,
+                erp_core::events::build_event_payload(serde_json::json!({
+                    "patient_id": patient_id,
+                    "action_type": action_type,
+                    "params": params,
+                })),
+            );
+            event_bus.publish(event, db).await;
+        }
+        _ => {}
+    }
+}
+
+async fn create_pending_action(
+    db: &DatabaseConnection,
+    event_bus: &EventBus,
+    tenant_id: Uuid,
+    patient_id: Uuid,
+    doctor_id: Option<Uuid>,
+    action_type: &str,
+    params: &serde_json::Value,
+    risk_level: &str,
+    decision: &DispatchDecision,
+) {
+    let event = erp_core::events::DomainEvent::new(
+        "health.ai_action.pending_approval",
+        tenant_id,
+        erp_core::events::build_event_payload(serde_json::json!({
+            "patient_id": patient_id,
+            "doctor_id": doctor_id,
+            "action_type": action_type,
+            "risk_level": risk_level,
+            "timeout_seconds": decision.response_timeout.map(|d| d.as_secs()),
+            "params": params,
+        })),
+    );
+    event_bus.publish(event, db).await;
+}
+
+#[cfg(test)]
+mod tests {
+    use super::*;
+
+    #[test]
+    fn route_low_risk_to_auto_execute() {
+        let decision = dispatch_decision("low", "alert");
+        assert_eq!(decision.execution_mode, ExecutionMode::AutoExecute);
+        assert_eq!(decision.response_timeout, None);
+    }
+
+    #[test]
+    fn route_medium_risk_to_doctor_review() {
+        let decision = dispatch_decision("medium", "followup");
+        assert_eq!(decision.execution_mode, ExecutionMode::DoctorReview);
+        assert_eq!(decision.response_timeout, Some(Duration::from_secs(86400)));
+    }
+
+    #[test]
+    fn route_high_risk_to_urgent_confirm() {
+        let decision = dispatch_decision("high", "alert");
+        assert_eq!(decision.execution_mode, ExecutionMode::UrgentConfirm);
+        assert_eq!(decision.response_timeout, Some(Duration::from_secs(14400)));
+    }
+
+    #[test]
+    fn route_unknown_defaults_to_doctor_review() {
+        let decision = dispatch_decision("unknown", "followup");
+        assert_eq!(decision.execution_mode, ExecutionMode::DoctorReview);
+        assert_eq!(decision.response_timeout, Some(Duration::from_secs(86400)));
+    }
+}
diff --git a/crates/erp-health/src/service/mod.rs b/crates/erp-health/src/service/mod.rs
index 3dbb065..7c244e3 100644
--- a/crates/erp-health/src/service/mod.rs
+++ b/crates/erp-health/src/service/mod.rs
@@ -1,3 +1,4 @@
+pub mod ai_action_dispatcher;
 pub mod alert_engine;
 pub mod alert_rule_service;
 pub mod alert_service;