Appropriate planting and nitrogen application patterns to support high-quality production of cultivated forage in light of issues of water scarcity, extensive field husbandry, and low productivity in cultivated grassland planting areas were investigated in this study. Using Medicago sativa L. (alfalfa) as the research object, this study analyzed the effects of planting patterns (conventional flat planting (FP) and ridge culture with film mulching (RM)) and nitrogen level (N0: 0 kg·ha−1, N1: 80 kg·ha−1, N2: 160 kg·ha−1, N3: 240 kg·ha−1) on the growth, yield, quality (crude protein content (CP), acid detergent fiber content (ADF), neutral detergent fiber content (NDF), and relative feeding value (RFV)), the water–nitrogen use efficiency, and economic benefits (EB) of alfalfa in the year of establishment. Results demonstrated that (1) RM might greatly increase the growth of alfalfa when compared to FP. The plant height, stem diameter, and leaf:stem ratio of alfalfa all increased under the same planting patterns before decreasing as the nitrogen application rate (NAR) increased. (2) Appropriate NAR combined with RM could improve the yield and quality of alfalfa. Compared with other treatments, the yield, CP, and RFV under RMN2 treatment increased by 5.9~84.9%, 4.9~28.6%, and 19.6~49.3%, respectively, and the ADF and NDF decreased by 14.0~27.6% and 13.0~26.1%, respectively. (3) Under the same nitrogen level, RM showed better performance than FP in terms of water use efficiency (WUE), irrigation water use efficiency (IWUE), precipitation use efficiency (PUE), partial factor productivity of nitrogen (PFPN), agronomic nitrogen use efficiency (ANUE), and EB of alfalfa. Under the same planting pattern, PFPN decreased as the NAR increased, while WUE, IWUE, PUE, ANUE, and EB first increased and then decreased as the NAR increased and reached a maximum value under the N2 condition. In conclusion, the RM planting pattern combined with a nitrogen level of 160 kg·ha−1 can significantly promote alfalfa growth as well as the yield, quality, water–nitrogen use efficiency, and EB of alfalfa, making it a suitable planting management mode for alfalfa production in the Yellow River irrigation region in Gansu Province, China and areas with similar climate.
