The Quadruple Aim and Homelessness: A Framework for Evaluating Program- and System-level Outcomes and Prioritizing Effective Interventions in Policy.

Homelessness rates are increasing in North America, and the service systems that support people experiencing homelessness have been transformed by the COVID-19 pandemic and overdose crisis. There is an urgent need to evaluate the program- and system-level outcomes of transformed service delivery approaches and emergent innovations for people experiencing homelessness using a multifaceted approach. We propose that the Quadruple Aim is well-positioned and highly relevant for optimizing service delivery to people experiencing homelessness. Each of its four aims-[1] improving population health, [2] providing a positive experience of care, [3] reducing care costs, and [4] promoting workforce health and wellness-target critical domains associated with homelessness and service delivery. The Quadruple Aim can be used to organize and assess intervention evidence, which we highlight using Housing First as an example, enabling policymakers and researchers to use these assessments to optimally advance the health of people experiencing homelessness.