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  • Investigating Psychosocial Factors: Supporting Clinical Decisions for Outpatient Diabetes Care

    by

    Charles R. Senteio

    A dissertation submitted in partial fulfillment of the requirements for the degree of

    Doctor of Philosophy (Information)

    in the University of Michigan 2015

    Doctoral Committee:

    Associate Professor Tiffany Veinot, Chair Assistant Professor Julia Adler-Milstein Associate Professor Caroline R. Richardson Associate Professor Kai Zheng

  • © Charles R. Senteio 2015

  • ii

    To Mother and Dad Happy are those who dream dreams, and are willing to pay the price to make them come true.

    In pursuit of our higher ground, indeed, we find our path by walking it.

  • iii

    ACKNOWLEDGEMENTS

    This dissertation has achieved one measure of success by answering my research

    questions, which were refined and honed through the tireless support of the dissertation

    committee, several other researchers, colleagues, and other health care practitioners. It is

    also successful in that it helps fulfill a personal goal, conceived over a decade ago. At that

    time, I began to understand the chasm that existed between practitioners and certain at-

    risk patients. Over the course of hundreds of home visits and clinical consultations, I

    witnessed at-risk patients lament that the health care “system” failed to understand their

    plight; I also had the opportunity to work with highly skilled practitioners who expressed

    frustration with not knowing enough about—or learning too late of—the persistent

    structural and individual circumstances that afflicted certain patients who simply could

    not overcome various barriers to care. At that time, I committed to a journey to do what I

    could to help close that chasm, to participate meaningfully in extending the capabilities of

    “personalized” medicine, and to better incorporate the patient’s social and environmental

    experience into the chronic care clinical consultation to facilitate better outcomes. This

    dissertation is an important step in that journey; it represents the last, major academic

    milestone in my time as a doctoral student at the University of Michigan School of

    Information, time that has included earning a Master’s degree from the School of Social

    Work. I am extremely fortunate to have had the support of many individuals that made

    this step possible.

  • iv

    I deeply appreciate the support and guidance from my dissertation chair and

    advisor, Dr. Tiffany Veinot. I still recall our conversation in April, 2011 when I told you I

    would be coming back to Michigan for my doctoral studies. I would be returning to the

    university that had already played a significant role in my personal and professional

    development as a Master’s student in Business Administration, then as an alumnus. I

    appreciated the joy you conveyed through the phone when I informed you of my

    decision. I noted that same enthusiasm when you informed me of the honor of being

    awarded the Gary M. Olson Outstanding Ph.D. Student Award. You have been an

    influential presence, a true scholar, who has been consistent in your tireless efforts to

    support my development as a researcher. I appreciate you helping me to expand my

    network, through introductions to the wonderful people at the Veterans Administration,

    faculty at other institutions, and members of your network dedicated to executing quality

    research work and translating it into practice. Thank you especially for connecting me to

    special people like Terrance Campbell, Dave Law, and Tammy Toscos.

    I established three simple criteria when I began contemplating potential members

    of my dissertation committee: 1) proven scholars who could help augment my research

    needs, 2) ability to work well with me, and each other, and 3) clear demonstration of

    genuine passion for their work. Each of you have gone well beyond my expectations for

    providing me the level and type of support I sought. Thank you. Julia Adler-Milstein, I

    had the privilege to meet and get to know you when I took your health policy course in

    the fall of 2011, my first semester at the School of Information. You have been a source

    of constant support and pragmatic counsel, no matter the type of question or issue I

    brought to you. Thank you, Kai Zheng, for consistently responding to my requests for

  • v

    support. You, like Tiffany and Julia, were part of my comprehensive exam, and

    dissertation committee. I will always appreciate your support for my dissertation and my

    other work in healthcare. Caroline Richardson, you have been a constant source of

    support since I first asked if you would be willing to serve on my dissertation committee.

    Your clinical perspectives have been invaluable in helping to shape this study. You also

    have granted me access to your network of other physicians. That access has greatly

    enhanced this work. I will always cherish the time and effort each of you provided,

    essential in enabling me to complete this work.

    There are several other researchers who have helped me execute this work. Jim

    Walton, your skill as a clinician and strategic thinker helped me shape this work long

    before I started the doctoral program; access to your organization was indispensable to

    this effort. Thank you for your friendship. Julie Lowery. I will always cherish our spirited

    debates about the relevance of this work. You have pushed me even further in helping me

    shape my own priorities for translational research. Your spirit and competence continue

    to inspire. Thank you, James Dickens, Badia Harlin, and Martha Funnell for offering

    your rich insights on non-physician practitioners and diabetes care. Furthermore, I deeply

    appreciate your considerable efforts in providing me access to the professional

    organizations you lead.

    I would also like to express my gratitude for individuals at the Veterans

    Administration in Ann Arbor who provided support and guidance throughout this project:

    Tammy Chang, Alicia Cohen, Elissa Gaies, and Beverly Hall. In addition, my

    involvement in the Disparities Leadership Program at Massachusetts General Hospital

    provided me with the opportunity to work with, and learn from, national leaders who

  • vi

    work with at-risk patient populations. A very special thanks to: Aswita Tan-McGrory,

    Joseph R. Betancourt, Liz Trevino, Derrick Villa, Cunegundo “Connie” Vergara, Zoila

    Torres Feldman, Gavin Muir, and Kris McCracken.

    I am very pleased to acknowledge the faculty at the School of Information who

    have been a tremendous source of support and guidance: Paul Edwards, Mark Ackerman,

    David Wallace, John King, Lionel Robert, Olivia Frost, Jeff MacKie-Mason, Tom

    Finholt, Eric Cook, Kristin Fontichiaro, Chuck Friedman, Tawanna Dillahunt, Stephanie

    Teasley, and Beth Yakel. I also would like to express my gratitude to School of

    Information staff for their support over the past four years: Beth Zibro, Judy Lawson,

    Barb Smith, Veronica Falandino, Jay Jackson, Ben Armes, Glenda Bullock, Sue Schoen,

    Mike Doa, Lai Tutt, Jim Schmidt, Heather Carpenter, Heather Newman, Rebecca

    O’Brien, Sheryl Smith, Lorraine Robert, Shamille Orr, and Kathleen O’Connor.

    I have been privileged to be a part of a student community that is as supportive as

    any I have known. I want to extend a very special thanks to the School of Information

    students who have been so supportive: Devan Donaldson, Pablo Quinones, Andrea

    Barbarin, Melody Ku, Tawfiq Ammari, Karina Kervin, Chris Wolf, Danny Wu, Allen

    Flynn, Christa Meadowbrooke, Elizabeth Kaziunas, Adam Kriesberg, Gaurav Paruthi,

    Carrie Xu, Melissa Chalmers, Rayoung Yang, Xin Rong, Jasmine Jones, and a very

    special thank you to Ms. Lois Street.

    There are other University of Michigan faculty, staff and students I would like to

    thank for their support in helping to make this experience so fulfilling. I will cherish your

    guidance and support. Thank you, Diane Vinokur and Jerry Davis. You both have served

    as wonderful, familiar sounding boards for so many of my ideas over these many years.

  • vii

    You helped me transition back to Ann Arbor as a full time student. Other University of

    Michigan faculty and staff have provided me with advice and support as I worked

    through the program: Greg Merritt, Renee R. Anspach, Tim McDaniel, Daphna

    Oyserman, Daniel Keating, Sofia Merajver, Bob Anderson, Bob Quinn, and Shyamala

    Nagaraj. Also, faculty and staff at the School of Social Work offered me endless support:

    Mike Spencer, and Ricardo Guzman, Laura Sanders, Karen Staller, William Vanderwill,

    Sue Crab, and Leslie Hollingsworth. Thank you to those I had the tremendous privilege

    to meet and get to know through the Dean of Students Advisory Board: Dean Laura

    Jones, Rachel Naasko, Andrew Kruger, Luciana Aenășoaie, and Bro. Canon Thomas.

    I would also like to express my deepest thanks to two individuals I had the

    privilege t

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