: The current National Health Accounts (NHA) track health expenditures by type of service delivered and source of funding. Despite following these inputs, they have not concomitantly measured outputs, which are the outcomes of patients benefiting from these expenditures and, ultimately, the improvement in population health. The value of health-related expenditures, whose measurement requires knowledge of both inputs ? and outputs, has therefore not been tracked. The objective of revising the NHA is to measure trends in costs and outcomes for 32 high impact conditions, as designated by magnitude of healthcare expenditures or effect on health (based on prevalence, morbidity, or mortality). Following this, population health will be modeled to quantify the contribution to health of expenditures associated with these diseases. The cost-effectiveness of treatment for patients with high impact respiratory diseases will be assessed, beginning with an evaluation of the trends in community-acquired pneumonia (CAP) patients. Specifically, the changes over time in comorbidity-adjusted mortality rates of patients with CAP will be measured. These rates (as a health outcome and the primary output) will be compared to costs of care to assess for temporal changes in the value of CAP-related health care expenditures. Overall population incidence and mortality rates will be assessed based on data from two sources: (1) the National Health Interview Survey (NHIS), which is linked with the National Death Index; (2) Medicare claims data, which is available from 1987 - 2001. The Medicare data includes cost data and will thus also allow for patient-level analysis of comorbidity clusters' influence on mortality and resource utilization. Although the absence of cost data will prevent patient-level value measurement, NHIS-based population ? estimates of incidence and mortality will be used with pneumonia-related expenditure data from the NHA to estimate trends in value for patients less than 65. Healthcare Cost & Utilization Project (HCUP) data is also being used to assess comorbidity, mortality, and cost trends in hospitalized patients. The availability of cost data in HCUP will allow for detailed subgroup analyses. ? This project is relevant to the goals of the AHRQ, which include assuring quality and achieving efficiency through access, reductions in health care costs, and value-based purchasing. Since CAP is associated with many chronic illnesses, the proposed investigation is also relevant to AHRQ's goal of understanding the care of individuals with multiple health conditions. This research effort has important policy implications because it will provide data that will serve as a rational guide to healthcare resource allocation decisions. ? ? ?
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| Ruhnke, Gregory W; Coca-Perraillon, Marcelo; Kitch, Barrett T et al. (2011) Marked reduction in 30-day mortality among elderly patients with community-acquired pneumonia. Am J Med 124:171-178.e1 |
| Ruhnke, Gregory W; Coca-Perraillon, Marcelo; Kitch, Barrett T et al. (2010) Trends in mortality and medical spending in patients hospitalized for community-acquired pneumonia: 1993-2005. Med Care 48:1111-6 |
