目的: 通过分析样本医院DIP付费前后急性上呼吸道感染住院患者基本情况、诊疗情况、住院费用变化情况,为DIP改革提供实证数据支撑。方法: 收集2019年7月至2023年6月淄博市某院儿科急性上呼吸道感染（收治数量第一的病种）住院患者相关信息,根据淄博DIP付费实际落地时间,分为改革前和改革后两组;采用卡方检验对基本信息进行组间差异性分析,采用Mann-Whitney U检验对费用的组间差异进行分析;采用灰色关联分析和结构变动度分析患者住院总费用和分项费用变化情况。结果: DIP改革后,患者年龄段、住院天数分组、住院费用分层发生变化;一般医疗服务费取代西药费成为住院费用的最大关联因素;急性上呼吸道感染患者住院费用总结构变动度为52.30%,对住院费用正向结构变动贡献率前三位依次为实验室诊断费、治疗一次性材料费、非手术治疗费;对住院费用结构负向结构变动贡献率前三位依次为临床诊断费、检查一次性材料费、西药费。结论: DIP改革对降低患者住院天数有促进意义,在一定程度上降低了患者住院费用,改善了住院费用结构,但仍需进一步优化。

Objective: The paper intends to provide empirical data for DIP reform by analyzing the basic situation, diagnosis and treatment situation, and changes in hospitalization cost of patients with acute upper respiratory tract infection before and after DIP reform in sample hospitals. Methods: The relevant information of the first type of acute upper respiratory tract infection patients admitted to a pediatric hospital in Zibo City from July 2019 to June 2023 was collected. According to the actual implementation time of DIP in Zibo City, the patients were divided into pre-reform group and post-reform group, and the basic information was analyzed by Chi-square test. The difference between groups was analyzed by Mann-Whitney U test. Grey correlation analysis and structural variation were used to analyze the changes of total inpatient expenses and expenses of sub-items. Results: After the DIP reform, the age group of patients, the number of days in hospital and the stratification of hospitalization expenses changed. After the reform, the general medical service fee replaced the western medicine fee as the most relevant factor of hospitalization cost. The total structural change of inpatient cost of acute upper respiratory tract infection was 52.30%, and the top three factors influencing the positive structural change of inpatient cost were laboratory diagnosis cost, treatment disposable material cost, and non-surgical treatment cost. The top three factors influencing the negative structural change of hospitalization cost structure were clinical diagnosis cost, inspection disposable material cost, and western medicine cost. Conclusion: The reform of DIP payment mode can reduce the number of days of hospitalization, reduce the hospitalization cost and improve the structure of hospitalization cost to a certain extent, but it still needs to be further optimized.