Nominated for this competitive visiting faculty fellowship by MIT Professor Retsef Levi, the J. Spencer Standish (1945) Professor of Operations Management at the MIT Sloan School of Management, who studies how technology can support health care for underserved populations,
According to MIT, the Martin Luther King, Jr. Visiting Professor and Scholars Program was established to “. . . to enhance and recognize the contributions of outstanding scholars. The program honors the life and legacy of Dr. Martin Luther King Jr. by increasing the presence of minority scholars at MIT. Dr. Martin Luther King, Jr. Visiting Professors and Scholars enhance their scholarship through intellectual interactions with MIT peers and enrich the intellectual life of the Institute with their participation in MIT research and academic programs. Scholars are expected to be deeply engaged in the life of the Institute through teaching, research and other scholarly interactions with the MIT community. Their presence gives them the opportunity to make a significant impact on the growth and awareness of undergraduate and graduate students, as well as the MIT community as a whole.”
The goal of the research Senteio and Levi will undertake this coming academic year will be guided by the question, “Why do patients with insurance and access to healthcare systems continue to visit the emergency room for chronic conditions that could and should be managed in ambulatory care settings?”
Senteio and Levi will collaborate to explore why people suffering from chronic health conditions such as diabetes, chronic pain, and heart disease, as well as mental health issues, seek care in emergency rooms as opposed to ambulatory care settings.
To conduct this research, they will collaborate with physicians at Massachusetts General Hospital in Boston and work with members of the local community.
A vexing part of the problem, Senteio said, is that while hospitals include education during the discharge process so that patients may be informed that emergency rooms are not the optimal place for them to seek care for their chronic health conditions, some patients continue to seek chronic care at emergency rooms. Therefore, another goal of their research is to understand what improvements in discharge planning, or other components of care delivery, may improve patient care.
Last year in an initial meeting with Senteio, held to discuss a potential project, Levi said he suspected that an information problem was at the root of these decisions. As a health informaticist focused on health equity, Senteio has found that information is part of the issue. However, he and Levi are also interested in exploring how social determinants may also play a role.
Senteio suspects that some of the social factors driving people to emergency rooms for care include living in poverty, caregiver responsibilities, work demands, and prior negative experiences with seeking care. He also said barriers to care which could be addressed with enhanced care coordination and patient navigation could also be factors in improving care.
MIT’s MLK Program is providing Senteio and Levi with the opportunity to blend their unique combination of skills and research interests to design and execute a project which has the potential to improve health equity. Project findings could have a positive impact on a persistent, real-world problem.
Providing chronic care in emergency rooms is problematic, both for the patients and the emergency rooms, Senteio said. “We can use technology to better understand and address the barriers that result in patients seeking care in emergency rooms which can and should be treated in the ambulatory care setting. It is about six times more expensive to provide chronic disease care in an emergency room when compared to the ambulatory care setting,” Senteio said.
Senteio added that the problem with people going to the emergency room for help with chronic conditions is not new, but the issue is exacerbated during the COVID-19 pandemic.
“In general, there are two vital components for managing chronic disease care after patient discharge,” Senteio said. “One is to make sure they get necessary prescriptions filled, and the second is to ensure they make, and attend, a follow-up appointment. A better understanding of the barriers patients experience to completing these two steps holds the potential to reducing emergency room visits and subsequent admissions.”
The MIT visiting professorship will enable Senteio to expand the technology, health, and personal community-based research he has conducted in other locations during his career. “The community-based, engaged health research I conduct is predicated on the collaborative relationships which are critical to designing and completing health equity research. These relationships are critical to working with marginalized communities who have experienced decades of inequitable conditions which influence health outcomes.
“My sustained collaborative relationships are critical to executing this important work. We researchers must work to shed the reputation of just showing up when it’s time for us to start our next project. To persist in doing community-based work, it’s essential to be engaged with people, beyond just data collection activities. I believe that the results are richer when the voice of the community is included from project design to results dissemination. This work often involves deeply personal issues which require researchers to make connections with community-based individuals who help provide access to critical perspectives and beliefs which often inform the work. These perspectives have been informed by the literature and my personal experiences in conducting health equity research in Dallas, Texas and Flint, Michigan, and that’s how I intend to work at MIT in Boston to help answer the overarching research question Retsef and I are asking.”