A Study of Overcoming Social Determinants of Health

NCT05773313 | Completed Results

• 2 other identifiers: 22-012939UL1TR002377
• Study Type: interventional
• Target: 12
• Locations: 1 country
• Sites: 1

Brief Summary

This study is being done to determine if assistance in accessing community resources can improve health outcomes. Social determinants of health are the conditions in which individuals are born, work and live that can impact health. These can include access to healthcare, healthy food, education, safe neighborhoods, transportation, political and social environments that are safe and fair.

Conditions

Social Determinants of Health (SDOH)

Outcome Measures

Primary Outcomes (2)

• Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment

  Evaluated using the CMS Accountable Health SDOH Screening Tool used to assess patient needs across the following domains: house instability, food insecurity, transportation problems, utility help needs, interpersonal safety, financial strain, employment, family and community support, education, physical activity, substance use, mental health, and disabilities that community services can help with. If the participant chose the underlined option, they might have an unmet health-related social need. Only domains where an unmet health-related social need was identified was included in the analysis.

  Baseline and 12 months

• Change in Resilience

  Evaluated using the 6-item Brief Resilience Scale (BRS) questionnaire assessing the participants ability to bounce back on a 1-5 scale range. Total questions scores are divided by total number of questions answered for a final score range from 1.00-2.99 = low resilience; 3.00-4.30 = normal resilience; 4.31-5.00 = high resilience.

  Baseline and 12 months

Secondary Outcomes (3)

• Hospitalizations

  Baseline and 12 months

• Emergency Room Visits

  Baseline and 12 months

• Primary Care Visits

  Baseline and 12 months

Study Arms (1)

The Open Table Model

EXPERIMENTAL

Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) will meet with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution.

Behavioral: The Open Table

Interventions

The Open Table BEHAVIORAL

An organization that connects community volunteers to individuals in need to help overcome life's challenges.

The Open Table Model

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• \- Identified social determinants of health (SDOH). need that impacts healthcare outcomes (identified by the healthcare team)

You may not qualify if:

• Non-english speaking patients
• Patients who are pregnant

Sponsors & Collaborators

• Mayo Clinic: lead
• National Center for Advancing Translational Sciences (NCATS): collaborator

Study Sites (1)

Mayo Clinic Arizona

Scottsdale, Arizona, 85050, United States

Location

Related Links

• Mayo Clinic Clinical Trials

Results Point of Contact

• Title: Nathan Delafield, M.D.
• Organization: Mayo Clinic

Delafield.Nathan@mayo.edu

480-574-1920

Study Officials

• Nathan Delafield, MD

  Mayo Clinic

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: OTHER
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: March 10, 2023
• First Posted: March 17, 2023
• Study Start: June 15, 2023
• Primary Completion: July 17, 2024
• Study Completion: July 17, 2024
• Last Updated: July 17, 2025
• Results First Posted: July 17, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)