Leveraging a Province-Wide Electronic Health Record System to Integrate Health Promotion into Routine Hospital-based Care in Alberta, Canada- A Research Protocol for Evaluation.

Economic evaluation research has evolved considerably. Once focused mainly on healthcare, it now spans social care and integrated care services—an important shift for addressing the needs of people who are often overlooked, such as those with experience of homelessness (PEH) and multiple disadvantage (defined as overlapping experiences of homelessness, substance use, mental health issues, and justice involvement) []. Understanding what matters most to these individuals is challenging because of their complex circumstances. Traditional research methods frequently fail to capture their priorities, leaving gaps in how services respond to real-world needs []. Homelessness, particularly multiple exclusion homelessness, is a deeply complex issue with significant social and economic consequences []. It is linked to poorer health outcomes, premature mortality, increased use of emergency healthcare, greater involvement with the justice system, and reduced work productivity []. People experiencing homelessness (PEH) face profound health inequities driven by social determinants such as poverty, unstable or absence of housing, and limited access to coordinated care. This can lead to delays, gaps, and missed opportunities for recovery []. Integrated care provides a framework for addressing these challenges by promoting person-centred, joined-up services across health, housing, and social support. The International Foundation for Integrated Care (IFIC) identifies nine pillars of integration, including, for example, “people as partners in care,” “population health management,” and “co-ordinated care”, all critical for improving outcomes for PEH []. Within this context, Out-of-Hospital Care (OOHC) models, such as step-down care, play a pivotal role in reducing hospital admissions and supporting recovery in community settings. However, designing OOHC services that reflect the preferences of PEH remains a challenge, particularly given the complexity of multiple exclusion homelessness. Understanding these preferences is essential for creating equitable, person-centred care pathways.