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| ID | Type | Description | Link |
|---|---|---|---|
| UL1TR002377 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Center for Advancing Translational Sciences (NCATS) | NIH |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 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. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| The Open Table | Behavioral | An organization that connects community volunteers to individuals in need to help overcome life's challenges. |
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| Measure | Description | Time Frame |
|---|---|---|
| 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 |
| Measure | Description | Time Frame |
|---|---|---|
| Hospitalizations | Difference in total number of hospitalizations in the 12 months before intervention and 12 months during intervention. | Baseline and 12 months |
| Emergency Room Visits | Difference in total number of emergency room visits in the 12 months before intervention and 12 months during intervention. |
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Inclusion Criteria:
- Identified social determinants of health (SDOH). need that impacts healthcare outcomes (identified by the healthcare team)
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nathan Delafield, MD | Mayo Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mayo Clinic Arizona | Scottsdale | Arizona | 85050 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40912931 | Derived | Delafield NL, Havanur A, Bonner TJ, Horsley R, Mead-Harvey C, Bersoux S, White K, Ali N, Milam AJ. A Community-Based Intervention to Address Social Determinants of Health: A Pilot Study. Jt Comm J Qual Patient Saf. 2025 Nov;51(11):727-732. doi: 10.1016/j.jcjq.2025.08.002. Epub 2025 Aug 7. |
| Label | URL |
|---|---|
| Mayo Clinic Clinical Trials | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | 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. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | 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. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | 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. | 3 participants did not complete the CMS accountable health SDOH screening assessment at 12 months. | Posted | Count of Participants | Participants | Baseline and 12 months |
|
Adverse Events were collected from the time of informed consent through study completion, approximately 12 months.
Only adverse events related to the intervention were collected.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | 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. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Nathan Delafield, M.D. | Mayo Clinic | 480-574-1920 | Delafield.Nathan@mayo.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 23, 2024 | Jun 3, 2025 | Prot_SAP_000.pdf |
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| Baseline and 12 months |
| Primary Care Visits | Difference in total number of primary care visits in the 12 months before intervention and 12 months during intervention. | Baseline and 12 months |
| years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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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 | 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. | 3 participants did not complete the BRS questionnaire at 12 months. | Posted | Mean | Standard Deviation | score on a scale | Baseline and 12 months |
|
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|
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| Secondary | Hospitalizations | Difference in total number of hospitalizations in the 12 months before intervention and 12 months during intervention. | Posted | Mean | Standard Deviation | Hospitalizations | Baseline and 12 months |
|
|
|
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| Secondary | Emergency Room Visits | Difference in total number of emergency room visits in the 12 months before intervention and 12 months during intervention. | Posted | Mean | Standard Deviation | Visits | Baseline and 12 months |
|
|
|
|
| Secondary | Primary Care Visits | Difference in total number of primary care visits in the 12 months before intervention and 12 months during intervention. | Posted | Mean | Standard Deviation | Visits | Baseline and 12 months |
|
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|
|
| 0 |
| 12 |
| 0 |
| 12 |
| 0 |
| 12 |
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