Background: The Diagnosis-Intervention Packet (DIP), a medical insurance payment management system utilizing big data, has been piloted in 12 cities by the National Healthcare Security Administration in China starting in 2021. Guangzhou is one of the pilot cities, and it has demonstrated significant success in the DIP payment reform, with its practical experience being affirmed and promoted by the National Health Department. In this study, researchers conducted field visits to a public hospital in Guangzhou to understand the internal responses to the DIP reform and the cognitive attitudes of relevant personnel. The analysis of the positive and negative factors affecting the implementation of the reform and the proposed measures to optimize internal hospital management are expected to provide practical evidence for the implementation of DIP payment reform in other public hospitals.

Methods: This study develops an interview guide based on the Consolidated Framework for Implementation Research (CFIR) and conducts one-on-one semi-structured interviews offline with personnel from a Grade A tertiary public hospital in Guangzhou. Employing rapid qualitative analysis techniques and utilizing NVivo 14.0 for coding CFIR-structured texts related to implementation, the study integrates five dimensions: innovation, inner and outer context, individuals, and the implementation process. It identifies factors that facilitate and hinder the implementation of the Diagnosis-Intervention Packet (DIP) payment reform, thereby proposing optimized internal management strategies for public hospitals to cope with DIP payment reforms.

Discussion: This study will provide significant insights for optimizing the internal management of public hospitals in the context of DIP payment reform. It offers a reference for optimizing internal management in tertiary public hospitals in China, aiming to achieve standardized, healthy, collaborative, and high-quality development.

Keywords: DIP Medicare payment methodology; internal management; meta-framework for implementation research (CFIR) framework; public health policy; public hospitals.

Copyright © 2025 Chang, Chen, Li, Yang, Luo, Yilamu, Fu, Xu, Liu and Tian.

背景： 中国的国家医疗保障局自2021年起在全国12个城市试点实施了利用大数据的疾病诊断相关分组（Diagnosis-Intervention Packet，DIP）医疗保险支付管理系统。广州是其中一个试点城市，在DIP支付改革方面取得了显著成功，其实践经验得到了国家卫生健康部门的认可和推广。在本研究中，研究人员前往广州市的一家公立医院进行实地考察，了解内部对DIP改革的反应及有关人员的认知态度。通过对影响改革实施的正面与负面因素的分析以及提出的优化医院内部管理措施，期望为其他公立医院推行DIP支付改革提供实际证据。

方法： 本研究基于实施研究综合框架（Consolidated Framework for Implementation Research, CFIR）开发了访谈指南，并对广州市一家三级甲等公立医院的人员进行了线下一对一的半结构化访谈。采用快速质性分析技术，利用NVivo 14.0软件对与实施相关的CFIR结构化文本进行编码，研究整合创新、内部和外部环境、个体以及实施过程五个维度，识别影响疾病诊断相关分组（DIP）支付改革的因素，并提出优化公立医院内部管理策略以应对DIP支付改革。

讨论： 本研究将为在DIP支付改革背景下优化公立医院内部管理提供重要见解。它为中国三级公立医院的内部管理优化提供了参考，旨在实现标准化、健康化、协作化和高质量的发展。

关键词： DIP医疗保险支付方法；内部管理；实施研究元框架（CFIR框架）；公共卫生政策；公立医院。