【摘要】 目的 探讨在按病种分值付费（Diagnosis-Intervention Packet,DIP）的运行背景下，结合预住院模式，在降低医疗费用、平均住院日上是否存在交互作用以及交互作用在不同科室、病种之间是否有差异。方法 基于贵州省人民医院2021年7—12月71 453例患者的真实世界数据，采用两因素方差分析方法，在交互效应差异有统计学意义的情况下，使用参数估计来判断交互作用的效应值和方向，进一步进行科室、病种的亚组分析。结果 在未进行调整时，医疗总费用和平均住院日均表现出负向交互作用（P<0.05）。亚组分析结果显示：在医疗总费用方面，外科系统的效应值为0.18%，低于内科系统的0.70%；核心病种的效应值为6.62%，低于综合病种的7.71%。在平均住院日方面，外科系统的效应值为0.55%，优于内科系统的0.22%；核心病种的效应值为8.70%，高于综合病种的2.90%。结论 DIP支付方式改革与预住院模式的结合展现出协同效应，有效地减少了患者的医疗费用和住院时长，这种效应受到疾病复杂性和诊疗流程规范性的影响。更多还原

【Abstract】 Objective Under the operation background of Diagnosis-Intervention Packet(DIP),whether there is interaction between reducing medical cost and average length of stay combined with pre-hospitalization mode,and whether there is difference between different departments and diseases in interaction. Methods Based on real-world data from 71 453 patients admitted to Guizhou Provincial People’s Hospital from July to December 2021,a twoway analysis of variance was employed. When the interaction effect was statistically significant, parameter estimation was used to determine the magnitude and direction of the interaction effect, followed by subgroup analyses by department and disease. Results Without adjustment, both total medical costs and average length of stay exhibited a negative interaction effect(P<0.05). Subgroup analyses revealed that in terms of total medical costs, the effect size for the surgical system was 0.18%, lower than that for the internal medicine system(0.70%); for core diseases, it was 6.62%, lower than that for comprehensive diseases(7.71%). Regarding average length of stay,the effect size for the surgical system was 0.55%,better than that for the internal medicine system(0.22%); for core diseases, it was 8.70%, higher than that for comprehensive diseases(2.90%).Conclusion The combination of DIP payment reform and pre-admission management model demonstrates a synergistic effect, effectively reducing patients’ medical costs and length of stay. This effect is influenced by disease complexity and the standardization of diagnostic and treatment processes.更多还原