Trial Outcomes & Findings for A Study of Overcoming Social Determinants of Health (NCT NCT05773313)

NCT ID: NCT05773313

Last Updated: 2025-07-17

Results Overview

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.

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 12 participants
• Primary outcome timeframe: Baseline and 12 months
• Results posted on: 2025-07-17

Participant Flow

Participant milestones

Measure	The Open Table Model Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) met with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution. The Open Table: An organization that connects community volunteers to individuals in need to help overcome life's challenges.
Overall Study STARTED	12
Overall Study COMPLETED	9
Overall Study NOT COMPLETED	3

Reasons for withdrawal

Measure	The Open Table Model Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) met with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution. The Open Table: An organization that connects community volunteers to individuals in need to help overcome life's challenges.
Overall Study Lost to Follow-up	3

Baseline Characteristics

A Study of Overcoming Social Determinants of Health

Baseline characteristics by cohort

Measure	The Open Table Model n=12 Participants Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) met with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution. The Open Table: An organization that connects community volunteers to individuals in need to help overcome life's challenges.
Age, Continuous	46.0 years STANDARD_DEVIATION 18.01 • n=5 Participants
Sex: Female, Male Female	8 Participants n=5 Participants
Sex: Female, Male Male	4 Participants n=5 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	6 Participants n=5 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	3 Participants n=5 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	3 Participants n=5 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=5 Participants
Race (NIH/OMB) Asian	0 Participants n=5 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants
Race (NIH/OMB) Black or African American	3 Participants n=5 Participants
Race (NIH/OMB) White	7 Participants n=5 Participants
Race (NIH/OMB) More than one race	1 Participants n=5 Participants
Race (NIH/OMB) Unknown or Not Reported	1 Participants n=5 Participants
Region of Enrollment United States	12 participants n=5 Participants

PRIMARY outcome

Timeframe: Baseline and 12 months

Population: 3 participants did not complete the CMS accountable health SDOH screening assessment at 12 months.

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.

Outcome measures

Measure	The Open Table Model n=12 Participants Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) met with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution. The Open Table: An organization that connects community volunteers to individuals in need to help overcome life's challenges.
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Food Insecurity-Baseline	6 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Food Insecurity-12 Months	5 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Financial Strain-Baseline	9 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Financial Strain-12 Months	5 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Family and Community Support-Baseline	10 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Family and Community Support-12 Months	7 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Physical Activity-Baseline	9 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Physical Activity-12 Months	7 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Disability-Baseline	12 Participants
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment Disability-12 Months	8 Participants

PRIMARY outcome

Timeframe: Baseline and 12 months

Population: 3 participants did not complete the BRS questionnaire at 12 months.

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.

Outcome measures

Measure	The Open Table Model n=12 Participants Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) met with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution. The Open Table: An organization that connects community volunteers to individuals in need to help overcome life's challenges.
Change in Resilience Baseline	3.0 score on a scale Standard Deviation 0.94
Change in Resilience 12 Months	3.3 score on a scale Standard Deviation 0.98

SECONDARY outcome

Timeframe: Baseline and 12 months

Difference in total number of hospitalizations in the 12 months before intervention and 12 months during intervention.

Outcome measures

Measure	The Open Table Model n=12 Participants Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) met with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution. The Open Table: An organization that connects community volunteers to individuals in need to help overcome life's challenges.
Hospitalizations Baseline	0.3 Hospitalizations Standard Deviation 0.62
Hospitalizations 12 Months	0.3 Hospitalizations Standard Deviation 0.89

SECONDARY outcome

Timeframe: Baseline and 12 months

Difference in total number of emergency room visits in the 12 months before intervention and 12 months during intervention.

Outcome measures

Measure	The Open Table Model n=12 Participants Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) met with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution. The Open Table: An organization that connects community volunteers to individuals in need to help overcome life's challenges.
Emergency Room Visits Baseline	1.7 Visits Standard Deviation 1.50
Emergency Room Visits 12 Months	1.2 Visits Standard Deviation 1.85

SECONDARY outcome

Timeframe: Baseline and 12 months

Difference in total number of primary care visits in the 12 months before intervention and 12 months during intervention.

Outcome measures

Measure	The Open Table Model n=12 Participants Subjects identified as having their health negatively impacted by Social Determinants of Health (SDOH) met with The Open Table members to determine their specific needs, decide on a plan for overcoming this need and following up to ensure resolution. The Open Table: An organization that connects community volunteers to individuals in need to help overcome life's challenges.
Primary Care Visits Baseline	8.3 Visits Standard Deviation 6.94
Primary Care Visits 12 Months	5.5 Visits Standard Deviation 5.32

Adverse Events

The Open Table Model

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Nathan Delafield, M.D.

Mayo Clinic

Phone: 480-574-1920

Email: Delafield.Nathan@mayo.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place