New tool aims to connect patients with housing and food resources

NCT ID NCT05574699

First seen Jun 26, 2026 · Last updated Jun 26, 2026

Summary

This study tested a clinical decision support tool that helps doctors identify social needs—like food, housing, or transportation—in African American patients with chronic diseases such as diabetes or heart failure. The tool uses a social risk score to flag patients who may need help and then refers them to community organizations. Researchers compared this approach to standard care in 251 patients to see if it improved how well social needs were addressed.

What this could mean

Our plain-language read of the trial. This is informational only — not medical advice or a prediction.

Active substance

Social risk score and clinical decision support tool

What this could lead to

If successful, this tool could help doctors better connect patients with community resources to address social needs like food or housing, potentially improving chronic disease management.

What could go wrong

This is a small pilot study with 251 participants, so results may not apply broadly. The tool only identifies needs—it does not guarantee that patients will receive help.

Disclaimer Read more

This is a summary of the original study . Summaries may miss details or leave out important information. Before applying or accepting participation, make sure you have read and understood the full study. Curemydisease.com takes no responsibility whatsoever for anything missed, misunderstood, or acted upon as a result of our summary — we know it does not capture everything.

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Conditions

The condition(s) this trial relates to.

Chronic Disease congestive heart failure diabetes mellitus heart failure hypertensive disorder

As listed by the trial registrant

The condition terms exactly as the trial's registrant entered them.

Contacts and locations

Locations

  • Johns Hopkins Bayview Medical Center - Comprehensive Care Practice

    Baltimore, Maryland, 21224, United States

  • Johns Hopkins Community Physicians - EBMC

    Baltimore, Maryland, 21202, United States

  • Johns Hopkins Community Physicians - Remington

    Baltimore, Maryland, 21211, United States

  • Johns Hopkins GreenSpring Station

    Baltimore, Maryland, 21093, United States

  • Johns Hopkins JHOC-GIM Clinic

    Baltimore, Maryland, 21287, United States