A Community-Based Intervention to Address Social Determinants of Health: A Pilot Study

This Innovation Report describes the feasibility and impact of an intervention focused on community-based social support to address social determinants of health (SDoH).

This study followed adult patients (N = 12) referred by primary care teams at a Federally Qualified Health Center (FQHC) due to unresolved SDoH needs. Over 12 months, community volunteers (the Open Table Network Table) were paired with patients to address their primary SDoH needs. Primary outcomes included the implementation of the Open Table Network Table and resolution of the patients' primary SDoH needs, measured by achieving patient-defined goals. Secondary outcomes evaluated intervention impact on patient resilience, healthcare utilization, and other SDoH metrics (for example, economic stability). Semistructured qualitative interviews were conducted with participants postintervention. Primary outcomes were assessed qualitatively; secondary outcomes were tested using paired analyses.

Twelve patients were enrolled over 12 months, and their SDoH needs ranged from healthcare access to social isolation. Community volunteers resolved 91.7% of these primary SDoH needs, with a median volunteer effort of 47.5 hours (interquartile range [IQR] 22.5-73.0) provided to each participant. No statistically significant differences were seen in patient resilience, other SDoH metrics, or healthcare utilization postintervention. The intervention was implemented (that is, the intervention was feasible), but there were challenges to implementation, including recruitment of patients, the need for multiple connections, and the time commitment required by volunteers.

The Open Table Network Table was implemented at an FQHC but required considerable volunteer effort and creativity. Further research is needed to assess the scalability, sustainability, and long-term social and clinical impact of this intervention.