A Study of Overcoming Social Determinants of Health

Not Applicable

Completed

• Conditions: Social Determinants of Health (SDOH)

• Registration Number: NCT05773313
• Lead Sponsor: Mayo Clinic

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.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2023-03-10
• Study First Submitted QC: 2023-03-10
• Study First Posted: 2023-03-17
• Study Start: 2023-06-15
• Primary Completion: 2024-07-17
• Study Completion: 2024-07-17
• Status Verified: 2025-06
• Results First Submitted: 2025-06-12
• Results First Submitted QC: 2025-06-27
• Last Update Submitted: 2025-06-27
• Results First Posted: 2025-07-17
• Last Update Posted: 2025-07-17

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 12

Inclusion Criteria

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

Exclusion Criteria

• Non-english speaking patients
• Patients who are pregnant

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Primary Outcome Measures

Name	Time	Method
Change in Participant Center for Medicare and Medicaid Services (CMS) Accountable Health Social Determinants of Health (SDOH) Screening Assessment	Baseline and 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.
Change in Resilience	Baseline and 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.

Secondary Outcome Measures

Name	Time	Method
Hospitalizations	Baseline and 12 months	Difference in total number of hospitalizations in the 12 months before intervention and 12 months during intervention.
Emergency Room Visits	Baseline and 12 months	Difference in total number of emergency room visits in the 12 months before intervention and 12 months during intervention.
Primary Care Visits	Baseline and 12 months	Difference in total number of primary care visits in the 12 months before intervention and 12 months during intervention.

Trial Locations

Locations (1)

Mayo Clinic Arizona; 🇺🇸 Scottsdale, Arizona, United States