{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:47:45Z","timestamp":1782841665293,"version":"3.54.5"},"reference-count":26,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"<jats:p>Japan's aging society concentrates pneumonia burden across communities, long\u2011term care, perioperative pathways, and hospitals. Adult pneumococcal and influenza vaccination are supported by trials and meta\u2011analyses and are often cost\u2011effective; yet, realized value depends on targeting, measurement, financing, and pairing with bedside prevention such as oral care and hospital\u2011acquired pneumonia bundles. This viewpoint proposes a formative, indicator\u2011driven architecture linking cost\u2011effectiveness to operations by aligning vaccination with complementary oral\u2011care prevention and value\u2011based payment under the existing policy infrastructure. Working within the Ministry of Health, Labour and Welfare\/Central Social Insurance Medical Council health technology assessment framework, Center for Outcomes Research and Economic Evaluation for Health methods, and claims\u2013electronic health record linkage via My Number insurance card, we specify a compact national indicator set: vaccination coverage and timeliness, nonventilator hospital\u2011acquired pneumonia, ventilator\u2011associated pneumonia, postoperative and stroke\u2011associated pneumonia, antibiotic days of therapy, and length of stay, with pragmatic risk adjustment and present\u2011on\u2011admission flags. Value levers first reward reliable reporting and adherence to evidence\u2011based bundles and then share verified, risk\u2011adjusted savings. Long\u2011term care facilities receive add\u2011ons for professional oral care in high\u2011risk residents; hospitals receive quality add\u2011ons and shared savings; perioperative pathways may incorporate oral health management; and stroke units standardize oral hygiene with dysphagia screening. A phased roadmap details the pilot co\u2011design, governance, risk\u2011adjusted reporting with equity safeguards, and iterative recalibration by using real\u2011world evidence. The learning loop\u2014measure, report, improve, generate evidence, adapt cost\u2011effectiveness, recalibrate payment\u2014converts modeled value into lived experience: fewer pneumonias, reduced antibiotic exposure, shorter stays, improved function, and dignity at favorable or potentially lower costs, context-depending on baseline pneumonia rates, implementation fidelity, and local unit costs.<\/jats:p>","DOI":"10.2196\/86912","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T21:55:06Z","timestamp":1772229306000},"page":"e86912","source":"Crossref","is-referenced-by-count":0,"title":["Designing an Indicator\u2011Driven, Value\u2011Based Architecture for Pneumonia Prevention in Japan: A Formative Policy Viewpoint on Adult Vaccination and Oral Care"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2270-2313","authenticated-orcid":false,"given":"Kazumi","family":"Kubota","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6307-6916","authenticated-orcid":false,"given":"Ataru","family":"Igarashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9835-6555","authenticated-orcid":false,"given":"Satoko","family":"Fujihara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0985-4267","authenticated-orcid":false,"given":"Kenichi","family":"Imai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref1","unstructured":"Vital statistics of JapanMinistry of Health, Labour and Welfare2026-02-20https:\/\/www.mhlw.go.jp\/english\/new-info\/2025.html"},{"key":"ref2","unstructured":"Annual report on the ageing society [summary] FY2025Cabinet Office Japan20252026-02-20https:\/\/www8.cao.go.jp\/kourei\/english\/annualreport\/2025\/pdf\/2025.pdf"},{"key":"ref3","unstructured":"Guidelines for the management of aspiration pneumonia  (in Japanese)The Japanese Respiratory Society2026-02-20https:\/\/www.jrs.or.jp\/publication\/file\/adult_pneumonia_2024v5.pdf"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2017.09.005"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1408544"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c1004"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004876.pub4"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70295-X"},{"key":"ref9","unstructured":"Guideline for preparing 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Quality2026-02-20https:\/\/www.ahrq.gov\/hai\/tools\/mrsa-prevention\/toolkit\/vap.html"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw353"},{"key":"ref17","unstructured":"Expert policy advocacy platform \u201cbetter use of cost-effectiveness evaluation for pharmaceuticals in Japan\"Health and Global Policy Institute20252026-02-20https:\/\/hgpi.org\/en\/research\/pf-20250507.html"},{"key":"ref18","unstructured":"Recommendation of the council on health data governanceOECD20172026-02-20https:\/\/legalinstruments.oecd.org\/en\/instruments\/OECD-LEGAL-0433"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0000553204.21342.01"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000177529.86868.8d"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.37737\/ace.1.3_76"},{"key":"ref22","unstructured":"Antimicrobial use and resistance (AUR) moduleNational Healthcare Safety Network20262026-02-20https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/11pscaurcurrent.pdf"},{"key":"ref23","author":"Iezzoni, L","year":"2012","journal-title":"Risk Adjustment for Measuring Health Care Outcomes, Fourth Edition"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.08.2291"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2022.172"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30325-0"}],"container-title":["JMIR Formative 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