Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based model

IntroductionHomelessness in the United States increased every year since 2016, with a 38% increase from 2023 to 2024. Much of the increase is attributable to rising home and rent costs, economic hardship caused by the recent pandemic, and the ending of protective legislation. Notably, people who exp...

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Main Authors: Danielle M. Kline, Pranav Padmanabhan, Sarah E. Brewer, Magdalena Cerdá, Elysia Versen, Katherine M. Keyes, Margot Kushel, Erin C. Wilson, Paul Wesson, Ayaz Hyder, Alaina Boyer, Alia Al-Tayyib, Joshua A. Barocas
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-08-01
Series:Frontiers in Public Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2025.1623385/full
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author Danielle M. Kline
Pranav Padmanabhan
Pranav Padmanabhan
Sarah E. Brewer
Sarah E. Brewer
Magdalena Cerdá
Elysia Versen
Katherine M. Keyes
Margot Kushel
Margot Kushel
Margot Kushel
Erin C. Wilson
Paul Wesson
Paul Wesson
Ayaz Hyder
Alaina Boyer
Alia Al-Tayyib
Joshua A. Barocas
Joshua A. Barocas
author_facet Danielle M. Kline
Pranav Padmanabhan
Pranav Padmanabhan
Sarah E. Brewer
Sarah E. Brewer
Magdalena Cerdá
Elysia Versen
Katherine M. Keyes
Margot Kushel
Margot Kushel
Margot Kushel
Erin C. Wilson
Paul Wesson
Paul Wesson
Ayaz Hyder
Alaina Boyer
Alia Al-Tayyib
Joshua A. Barocas
Joshua A. Barocas
author_sort Danielle M. Kline
collection DOAJ
description IntroductionHomelessness in the United States increased every year since 2016, with a 38% increase from 2023 to 2024. Much of the increase is attributable to rising home and rent costs, economic hardship caused by the recent pandemic, and the ending of protective legislation. Notably, people who experience homelessness have an increased risk of substance use disorders, HIV infection and poorer HIV outcomes than people who are stably housed. The iHouse model aims to develop feasible, effective, and cost-effective tailored approaches to improve health outcomes in this population including life expectancy, overdose, and HIV.Methods and analysisThe study will employ Group Model Building methods and use insights from that process to develop an agent-based model simulating the dynamic processes contributing to HIV incidence and treatment, overdose, and life expectancy among people along the housing and homelessness continuum in Denver, CO and San Francisco, CA. The model will evaluate multiple outcomes from 4 conceptual dimensions: (1) movement along the housing continuum, (2) population health (overdose and HIV incidence and life expectancy), (3) budgetary impact, (4) economic value.Ethics and disseminationThis study has been approved by the Colorado Institutional Review Board at the University of Colorado under protocol 24–0878. The data generated by this protocol, the methodologies used, and the findings will be made available in a timely manner to other researchers. iHOUSE code and parameter values will be published in Git Hub, such that all model analyses can be reproduced by independent investigators. Documentation of all parameter estimates and model results will be published for independent review and confirmation. In addition, supplemental materials and appendices for the model will be shared on a publicly available website.
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spelling doaj-art-02e4c4d1e8914ca48a8fdac685e19f8e2025-08-20T02:52:00ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-08-011310.3389/fpubh.2025.16233851623385Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based modelDanielle M. Kline0Pranav Padmanabhan1Pranav Padmanabhan2Sarah E. Brewer3Sarah E. Brewer4Magdalena Cerdá5Elysia Versen6Katherine M. Keyes7Margot Kushel8Margot Kushel9Margot Kushel10Erin C. Wilson11Paul Wesson12Paul Wesson13Ayaz Hyder14Alaina Boyer15Alia Al-Tayyib16Joshua A. Barocas17Joshua A. Barocas18Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, United StatesDivision of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, United StatesDepartment of Epidemiology, Colorado School of Public Health, Aurora, CO, United StatesAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, United StatesDepartment of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United StatesDepartment of Population Health, New York University Grossman School of Medicine, New York, NY, United StatesColorado Evaluation and Action Lab, University of Denver, Denver, CO, United StatesSchool of Public Health, Columbia University Medical Center, New York, NY, United StatesDivision of Health Equity and Society, University of California, San Francisco, San Francisco, CA, United StatesCenter for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States0Benioff Homeless and Housing Initiative, University of California, San Francisco, San Francisco, CA, United States1Public Health Foundation Enterprises, Inc., City of Industry, CA, United States0Benioff Homeless and Housing Initiative, University of California, San Francisco, San Francisco, CA, United States2Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States3Independent Consultant, DataToEngage, Futuwwa LLC, Columbus, OH, United States4National Health Care for the Homeless Council, Nashville, TN, United States5Public Health Institute at Denver Health, Denver, CO, United StatesDivision of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, United States6Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Colorado, Aurora, CO, United StatesIntroductionHomelessness in the United States increased every year since 2016, with a 38% increase from 2023 to 2024. Much of the increase is attributable to rising home and rent costs, economic hardship caused by the recent pandemic, and the ending of protective legislation. Notably, people who experience homelessness have an increased risk of substance use disorders, HIV infection and poorer HIV outcomes than people who are stably housed. The iHouse model aims to develop feasible, effective, and cost-effective tailored approaches to improve health outcomes in this population including life expectancy, overdose, and HIV.Methods and analysisThe study will employ Group Model Building methods and use insights from that process to develop an agent-based model simulating the dynamic processes contributing to HIV incidence and treatment, overdose, and life expectancy among people along the housing and homelessness continuum in Denver, CO and San Francisco, CA. The model will evaluate multiple outcomes from 4 conceptual dimensions: (1) movement along the housing continuum, (2) population health (overdose and HIV incidence and life expectancy), (3) budgetary impact, (4) economic value.Ethics and disseminationThis study has been approved by the Colorado Institutional Review Board at the University of Colorado under protocol 24–0878. The data generated by this protocol, the methodologies used, and the findings will be made available in a timely manner to other researchers. iHOUSE code and parameter values will be published in Git Hub, such that all model analyses can be reproduced by independent investigators. Documentation of all parameter estimates and model results will be published for independent review and confirmation. In addition, supplemental materials and appendices for the model will be shared on a publicly available website.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1623385/fullhousinghomelessgroup model buildingagent-based modelHIVsubstance use
spellingShingle Danielle M. Kline
Pranav Padmanabhan
Pranav Padmanabhan
Sarah E. Brewer
Sarah E. Brewer
Magdalena Cerdá
Elysia Versen
Katherine M. Keyes
Margot Kushel
Margot Kushel
Margot Kushel
Erin C. Wilson
Paul Wesson
Paul Wesson
Ayaz Hyder
Alaina Boyer
Alia Al-Tayyib
Joshua A. Barocas
Joshua A. Barocas
Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based model
Frontiers in Public Health
housing
homeless
group model building
agent-based model
HIV
substance use
title Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based model
title_full Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based model
title_fullStr Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based model
title_full_unstemmed Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based model
title_short Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based model
title_sort improving health and housing outcomes through a simulation and economic model an evidence based protocol of a group model building approach to develop an agent based model
topic housing
homeless
group model building
agent-based model
HIV
substance use
url https://www.frontiersin.org/articles/10.3389/fpubh.2025.1623385/full
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