{"edition":"usa","organization":"National Center for Healthy Housing","organizationId":"org:national-center-for-healthy-housing","boundaryVersion":"USA-50-states-DC-v1","updated":"2026-09-14","model":{"version":"usa-nchh-judgment-asthma-implementation-v2","costScope":"Ordinary unrestricted gift to NCHH nonprofit, including its full program and support portfolio. Annual comparison uses recipient-only GAAP expenses inclusive of donated services, excluding separate subsidiary spending. A societal model must additionally disclose implementation costs borne by public agencies, insurers, landlords and partners.","geographicAttribution":"50 states plus DC only. National research and coalition reach is observed; Puerto Rico/Guam and international collaborators are explicitly outside this edition. Marginal resident-weighted share is unknown, not inferred from headquarters or population.","formula":"C=2593580 annual full recipient GAAP cost. Y=K*dp*N*b*s; Qall=Y*(delta/14)*e*w*u/1.03; QUSA=Qall*g. K annual asthma implementation opportunities, dp net probability change attributable to NCHH rather than partners, N completed child-courses per successful implementation, b funding responsiveness, s no equivalent replacement, e clinical transport, w within-year retained timing, u recovered symptom-day utility. One year only; no extra mortality/hospital or recurring cohort credit.","counterfactual":"Without this gift, government contracts, other nonprofits, coalition members and payers continue working. Count only earlier or additional implemented services, not the total size of a restored appropriation or everyone served by a partner. Flexible gifts may replace other unrestricted funds or protect reserves; neither is automatically zero impact, but timing and additionality must be specified.","attribution":"The most uncertain variables are the gift's allocation and its causal effect on implementation. RAMP, local health departments, clinicians, landlords, other advocates and governments share production. Do not add asthma, falls and lead benefits for the same person without checking overlapping quality-of-life losses; do not add medical savings as QALYs.","uncertainty":"Implementation volume and additionality are explicitly judgmental; the source establishes a TA platform, not these yields. A finite partial-health central is useful despite weak parameters. All remaining lead, falls, policy and indoor-air effects are unpriced, not zero-valued.","nativeOutcomes":"20prospective opportunities*.15implementation change*50completed child-courses*.5funding response*.7nonreplacement=52.5 additional effective child-course-years before geography. Clinical transfer and timing are applied separately; trial symptom days are not automatically QALYs.","inputs":[{"name":"Illustrative gift G","value":100000,"unit":"USD","basis":"judgment","rationale":"Comparison scale only; not a restricted opportunity or minimum gift.","sourceIds":[]},{"name":"FY2025 recipient expense","value":2593580,"unit":"USD/year","basis":"observed","rationale":"NCHH column, consolidating statement, fiscal year ended September 30; full GAAP cost including in-kind.","sourceIds":["nchh-audit25"]},{"name":"Asthma trial symptom-free-day increment","value":2.1,"unit":"days/14 days","basis":"observed","rationale":"Randomized delivered intervention benchmark; not NCHH organizational effect.","sourceIds":["asthma-rct"]},{"name":"Asthma trial additional delivery cost","value":707.04,"unit":"2012 USD/participant","basis":"observed","rationale":"Historical intervention increment; excludes research/development and must not substitute for NCHH gift cost.","sourceIds":["asthma-rct"]},{"name":"Recovered symptom-day utility range","value":[0.05,0.2],"unit":"utility difference","basis":"judgment","rationale":"Illustrative sensitivity only; symptom-free status is not a directly measured preference-weighted utility. Not measured trial utility; the central uses the separate explicit 0.10 judgment.","sourceIds":[]},{"name":"Asthma benefit duration for hurdle calculation","value":1,"unit":"year","basis":"judgment","rationale":"Assumes full-year persistence of follow-up difference; requires validation, not a measured area under curve.","sourceIds":["asthma-rct"]},{"name":"K","value":20,"unit":"see formula","basis":"judgment","rationale":"20annual asthma-focused opportunities is a planning judgment smaller than78reported partners across two initiatives and multiple years;78is not annual independently attributable success.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"dp","value":0.15,"unit":"see formula","basis":"judgment","rationale":".15additional implementation probability attributable to NCHH after RAMP/government/other assistance; not measured.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"N","value":50,"unit":"see formula","basis":"judgment","rationale":"50completed child-courses per successful local implementation is modest clinic-scale planning, not observed TA volume.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"b","value":0.5,"unit":"see formula","basis":"judgment","rationale":".5funding response after restricted grants and other donations; not a funded pipeline.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"s","value":0.7,"unit":"see formula","basis":"judgment","rationale":".7fraction not replaced by equivalent public or insurer services; technical assistance may enable existing budgets.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"e","value":0.5,"unit":"see formula","basis":"judgment","rationale":"Half the trial symptom effect for differences in local delivery and case mix; not another trial adherence adjustment.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"w","value":0.75,"unit":"see formula","basis":"judgment","rationale":".75average retained benefit within the first year, then zero.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"u","value":0.1,"unit":"see formula","basis":"judgment","rationale":".1utility improvement on an avoided symptom day; explicit preference prior, not measured trial utility.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"g","value":0.95,"unit":"see formula","basis":"judgment","rationale":".95benefit within50states+DC; territorial activity excluded, no headquarters shortcut.","sourceIds":["nchh-ta","asthma-rct"]},{"name":"delta","value":2.1,"unit":"see formula","basis":"observed","rationale":"External randomized2.1additional symptom-free days per fortnight; not organizational causal yield.","sourceIds":["nchh-ta","asthma-rct"]}],"scenarios":[{"id":"central","label":"Best estimate — explicit partial-health judgment","costUSD":2593580,"allPopulationQalys":0.2867111650485437,"editionQalys":0.2723756067961165,"assumptions":"{\"K\":20,\"dp\":0.15,\"N\":50,\"b\":0.5,\"s\":0.7,\"e\":0.5,\"w\":0.75,\"u\":0.1,\"g\":0.95,\"delta\":2.1}. Finite prospective judgment, not observed throughput or confidence limits."},{"id":"low","label":"Weak joint judgment stress","costUSD":2593580,"allPopulationQalys":0.00008191747572815535,"editionQalys":0.00007372572815533982,"assumptions":"{\"K\":5,\"dp\":0.03,\"N\":20,\"b\":0.1,\"s\":0.3,\"e\":0.25,\"w\":0.5,\"u\":0.05,\"g\":0.9,\"delta\":2.1}. Finite prospective judgment, not observed throughput or confidence limits."},{"id":"high","label":"Favorable joint judgment stress","costUSD":2593580,"allPopulationQalys":21.233009708737868,"editionQalys":21.02067961165049,"assumptions":"{\"K\":40,\"dp\":0.3,\"N\":100,\"b\":0.75,\"s\":0.9,\"e\":0.9,\"w\":1,\"u\":0.2,\"g\":0.99,\"delta\":2.1}. Finite prospective judgment, not observed throughput or confidence limits."},{"id":"zero","label":"No additional net health","costUSD":2593580,"allPopulationQalys":0,"editionQalys":0,"assumptions":"No incremental implementation or no clinical benefit; no incremental harm."},{"id":"adverse","label":"Illustrative net health loss","costUSD":2593580,"allPopulationQalys":-1,"editionQalys":-1,"assumptions":"One net USA QALY lost through disruption, displaced care or adverse substitution; stress test, not an observed estimate."},{"id":"portfolio-unknown","label":"Remaining portfolio health unpriced","costUSD":2593580,"allPopulationQalys":null,"editionQalys":null,"assumptions":"Other non-overlapping pathways could add or subtract health; no invented portfolio uplift."}],"sensitivity":["At G=$100,000, T=$100,000 per 10 requires 10 USA QALYs; T=$1,000,000 per 10 requires 1. With q=0.0075–0.030 per effective child-year, required additional USA child-years are 333–1,333 or 33–133 respectively.","If an apparent gross service increase is only 10% attributable after coalition contribution/substitution, the necessary gross child-years are 10 times larger. If USA share is 90%, required all-population benefit is 11.1% larger; 90% is a diagnostic assumption, not observed allocation.","At the FY2025 full recipient budget, thresholds are 259.358 and 25.9358 USA QALYs annually. This is an institutional annual-benefit hurdle, not an estimate of marginal-gift productivity.","A fivefold change in persistent benefit or implementation yield changes the modeled price fivefold; zero net implementation gives no finite favorable price. Full societal costs rise when public downstream expenditures are counted.","Lead-related earnings or IQ cannot be monetized and silently relabeled QALYs. CAPABLE ADL gains require a validated utility and duration bridge; national policy gains require implementation and displacement evidence."],"missingInputs":["A current marginal unrestricted-funding plan separating research, coaching/regranting, advocacy and support, with costs and funded versus unfunded capacity.","Number and size of implementations caused or accelerated by incremental NCHH assistance versus no gift, including unsuccessful attempts and partner contributions.","For each implemented service: actual treatment completion, baseline risk, causal health effect, preference-based utility, duration and attrition.","Recipient-residence allocation excluding territories and non-USA spillovers, plus overlap between pathways.","Public/private replacement, displaced services and additional implementation costs; a completed policy win is insufficient evidence of future gift effect."]},"sources":[{"id":"nchh-framework","title":"NCHH Strategic Framework 2026–2030","publisher":"NCHH","url":"https://nchh.org/who-we-are/mission/2026-2030/","published":null,"retrieved":"2026-09-13"},{"id":"nchh-asthma","title":"Building Systems to Sustain Home-Based Asthma Services","publisher":"NCHH","url":"https://nchh.org/tools-and-data/financing-and-funding/building-systems-to-sustain-home-based-asthma-services/","published":"2026-05-05","retrieved":"2026-09-13"},{"id":"nchh-ta","title":"Technical Assistance to Improve Indoor Air Quality","publisher":"NCHH","url":"https://nchh.org/2024/10/customizable-technical-assistance-resources-and-support-available-to-augment-local-actions-to-improve-indoor-air-quality/","published":"2024-10-17","retrieved":"2026-09-13"},{"id":"nchh-impact","title":"Our Impact fact sheet","publisher":"NCHH","url":"https://nchh.org/resource-library/fact-sheet_our-impact.pdf","published":null,"retrieved":"2026-09-13"},{"id":"nchh-audit25","title":"Financial statements FY2025 and 2024: recipient schedule p20, notes pp14,17","publisher":"NCHH / Grandizio, Wilkins, Little & Matthews LLP","url":"https://nchh.org/resource-library/nchh-and-hhs_financial-statements_09-30-25_fy25.pdf","published":"2026-05-26","retrieved":"2026-09-13"},{"id":"nchh-audit24","title":"Financial statements FY2024 and 2023: recipient schedule p31","publisher":"NCHH / Grandizio, Wilkins, Little & Matthews LLP","url":"https://nchh.org/resource-library/nchh-and-hhs_financial-statements_09-30-24_fy24.pdf","published":"2025-02-17","retrieved":"2026-09-13"},{"id":"nchh-99024","title":"NCHH FY2024 Form 990, tax year 2023","publisher":"NCHH / IRS","url":"https://nchh.org/resource-library/nchh_form-990_2023_fy24.pdf","published":null,"retrieved":"2026-09-13"},{"id":"asthma-rct","title":"Community Health Worker Home Visits for Medicaid-Enrolled Children With Asthma: Effects on Asthma Outcomes and Costs","publisher":"Campbell et al., American Journal of Public Health / PMC","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC4605150/","published":"2015-08-13","retrieved":"2026-09-13"},{"id":"nchh-capable","title":"Aging Gracefully in Place: Evaluation of the CAPABLE Approach","publisher":"NCHH / HUD","url":"https://nchh.org/resource-library/report_aging-gracefully-in-place_an-evaluation-of-the-capability-of-the-capable-approach.pdf","published":"2020-05-18","retrieved":"2026-09-13"},{"id":"lead-rct","title":"Effect of Residential Lead-Hazard Interventions on Childhood Blood Lead Concentrations and Neurobehavioral Outcomes","publisher":"Braun et al., JAMA Pediatrics / PMC","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC6233767/","published":"2018-08-27","retrieved":"2026-09-13"},{"id":"nchh-fund","title":"Healthy Housing Transformation Fund","publisher":"NCHH","url":"https://nchh.org/build-the-movement/healthy-housing-transformation-fund/","published":"2024-08-05","retrieved":"2026-09-13"},{"id":"nchh-nys","title":"Saved: New York State's Healthy Neighborhoods Program","publisher":"NCHH","url":"https://nchh.org/2026/06/saved_new-york-states-healthy-neighborhoods-program/","published":"2026-06-09","retrieved":"2026-09-13"}]}