Browsing by Author "Kibbe, Warren"
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Item Open Access Use of a Digital Assistant to Report COVID-19 Rapid Antigen Self-test Results to Health Departments in 6 US Communities.(JAMA network open, 2022-08) Herbert, Carly; Shi, Qiming; Kheterpal, Vik; Nowak, Chris; Suvarna, Thejas; Durnan, Basyl; Schrader, Summer; Behar, Stephanie; Naeem, Syed; Tarrant, Seanan; Kalibala, Ben; Singh, Aditi; Gerber, Ben; Barton, Bruce; Lin, Honghuang; Cohen-Wolkowiez, Michael; Corbie-Smith, Giselle; Kibbe, Warren; Marquez, Juan; Baek, Jonggyu; Hafer, Nathaniel; Gibson, Laura; O'Connor, Laurel; Broach, John; Heetderks, William; McManus, David; Soni, ApurvImportance
Widespread distribution of rapid antigen tests is integral to the US strategy to address COVID-19; however, it is estimated that few rapid antigen test results are reported to local departments of health.Objective
To characterize how often individuals in 6 communities throughout the United States used a digital assistant to log rapid antigen test results and report them to their local departments of health.Design, setting, and participants
This prospective cohort study is based on anonymously collected data from the beneficiaries of the Say Yes! Covid Test program, which distributed more than 3 000 000 rapid antigen tests at no cost to residents of 6 communities (Louisville, Kentucky; Indianapolis, Indiana; Fulton County, Georgia; O'ahu, Hawaii; Ann Arbor and Ypsilanti, Michigan; and Chattanooga, Tennessee) between April and October 2021. A descriptive evaluation of beneficiary use of a digital assistant for logging and reporting their rapid antigen test results was performed.Interventions
Widespread community distribution of rapid antigen tests.Main outcomes and measures
Number and proportion of tests logged and reported to the local department of health through the digital assistant.Results
A total of 313 000 test kits were distributed, including 178 785 test kits that were ordered using the digital assistant. Among all distributed kits, 14 398 households (4.6%) used the digital assistant, but beneficiaries reported three-quarters of their rapid antigen test results to their state public health departments (30 965 tests reported of 41 465 total test results [75.0%]). The reporting behavior varied by community and was significantly higher among communities that were incentivized for reporting test results vs those that were not incentivized or partially incentivized (90.5% [95% CI, 89.9%-91.2%] vs 70.5%; [95% CI, 70.0%-71.0%]). In all communities, positive tests were less frequently reported than negative tests (60.4% [95% CI, 58.1%-62.8%] vs 75.5% [95% CI, 75.1%-76.0%]).Conclusions and relevance
These results suggest that application-based reporting with incentives may be associated with increased reporting of rapid tests for COVID-19. However, increasing the adoption of the digital assistant may be a critical first step.Item Open Access Utility of skin tone on pulse oximetry in critically ill patients: a prospective cohort study.(medRxiv, 2024-02-27) Hao, Sicheng; Dempsey, Katelyn; Matos, João; Cox, Christopher E; Rotemberg, Veronica; Gichoya, Judy W; Kibbe, Warren; Hong, Chuan; Wong, IanIMPORTANCE: Pulse oximetry, a ubiquitous vital sign in modern medicine, has inequitable accuracy that disproportionately affects Black and Hispanic patients, with associated increases in mortality, organ dysfunction, and oxygen therapy. Although the root cause of these clinical performance discrepancies is believed to be skin tone, previous retrospective studies used self-reported race or ethnicity as a surrogate for skin tone. OBJECTIVE: To determine the utility of objectively measured skin tone in explaining pulse oximetry discrepancies. DESIGN SETTING AND PARTICIPANTS: Admitted hospital patients at Duke University Hospital were eligible for this prospective cohort study if they had pulse oximetry recorded up to 5 minutes prior to arterial blood gas (ABG) measurements. Skin tone was measured across sixteen body locations using administered visual scales (Fitzpatrick Skin Type, Monk Skin Tone, and Von Luschan), reflectance colorimetry (Delfin SkinColorCatch [L*, individual typology angle {ITA}, Melanin Index {MI}]), and reflectance spectrophotometry (Konica Minolta CM-700D [L*], Variable Spectro 1 [L*]). MAIN OUTCOMES AND MEASURES: Mean directional bias, variability of bias, and accuracy root mean square (ARMS), comparing pulse oximetry and ABG measurements. Linear mixed-effects models were fitted to estimate mean directional bias while accounting for clinical confounders. RESULTS: 128 patients (57 Black, 56 White) with 521 ABG-pulse oximetry pairs were recruited, none with hidden hypoxemia. Skin tone data was prospectively collected using 6 measurement methods, generating 8 measurements. The collected skin tone measurements were shown to yield differences among each other and overlap with self-reported racial groups, suggesting that skin tone could potentially provide information beyond self-reported race. Among the eight skin tone measurements in this study, and compared to self-reported race, the Monk Scale had the best relationship with differences in pulse oximetry bias (point estimate: -2.40%; 95% CI: -4.32%, -0.48%; p=0.01) when comparing patients with lighter and dark skin tones. CONCLUSIONS AND RELEVANCE: We found clinical performance differences in pulse oximetry, especially in darker skin tones. Additional studies are needed to determine the relative contributions of skin tone measures and other potential factors on pulse oximetry discrepancies.