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Public Health

Use of a Digital Assistant to Report COVID-19 Rapid Antigen Self-test Results to Health Departments in 6 US Communities

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: August 26, 2022

Original Investigation

Article Information and Disclosures

Author Affiliations

¹Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
²Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
³Center for Clinical and Translational Science, University of Massachusetts Chan Medical School, Worcester
⁴CareEvolution, Ann Arbor, Michigan
⁵Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
⁶Center for Health Equity Research, Department of Social Medicine, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
⁷Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
⁸Washtenaw County Health Department, Washtenaw, Michigan
⁹Division of Infectious Disease, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
¹⁰Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester
¹¹National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, via contract with Kelly Services, Bethesda, Maryland
¹²Division of Cardiology, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
¹³Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, Worcester

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Key Points

Question How often do individuals use a digital assistant to log and report COVID-19 rapid antigen test results?

Findings This cohort study of 14 398 household beneficiaries of a COVID-19 test kit program in 6 US communities found that more than 75% of beneficiaries who used the digital assistant reported their rapid antigen test results to their state public health departments. Reporting behavior was significantly higher among communities that were incentivized for reporting test results.

Meaning These results suggest that application-based reporting with incentives may be associated with increased reporting of rapid tests for COVID-19.

Abstract

Importance 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.

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Article Information

Accepted for Publication: July 6, 2022.

Published: August 26, 2022. doi:10.1001/jamanetworkopen.2022.28885

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Herbert C et al. JAMA Network Open.

Corresponding Author: Apurv Soni, MD, PhD, Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA 01655 (apurv.soni@umassmed.edu).

Author Contributions: Dr Soni had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Herbert, Shi, Kheterpal, Suvarna, Durnan, Schrader, Singh, Cohen-Wolkowiez, Corbie, Kibbe, Marquez, Hafer, Gibson, O'Connor, Broach, Heetderks, McManus, Soni.

Acquisition, analysis, or interpretation of data: Herbert, Shi, Kheterpal, Nowak, Suvarna, Durnan, Behar, Naeem, Tarrant, Kalibala, Singh, Gerber, Barton, Lin, Kibbe, Baek, Hafer, O'Connor, Broach, Soni.

Drafting of the manuscript: Herbert, Shi, Baek, Soni.

Critical revision of the manuscript for important intellectual content: Herbert, Shi, Kheterpal, Nowak, Suvarna, Durnan, Schrader, Behar, Naeem, Tarrant, Kalibala, Singh, Gerber, Barton, Lin, Cohen-Wolkowiez, Corbie, Kibbe, Marquez, Hafer, Gibson, O'Connor, Broach, Heetderks, McManus, Soni.

Statistical analysis: Herbert, Shi, Naeem, Singh, Barton, Kibbe, Baek, Soni.

Obtained funding: Corbie, Hafer, Gibson, McManus, Soni.

Administrative, technical, or material support: Shi, Kheterpal, Nowak, Suvarna, Durnan, Schrader, Kalibala, Singh, Cohen-Wolkowiez, Corbie, Kibbe, Hafer, O'Connor, Broach, Heetderks, McManus.

Supervision: Singh, Cohen-Wolkowiez, Corbie, Hafer, O'Connor, Broach, Heetderks, McManus, Soni.

Conflict of Interest Disclosures: Mr Shi reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Kheterpal reported receiving an NIH contract to CareEvolution for integration of testing and digital health during the conduct of the study and being an employee and principal at CareEvolution. Mr Nowak reported being an employee of CareEvolution during the conduct of the study and outside the submitted work. Mr Durnan reported being employed by CareEvolution during the conduct of the study and being previously employed by AiCure outside the submitted work. Dr Naeem reported receiving grants from the NIH during the conduct of the study and outside the submitted work. Dr Barton reported receiving grants from the NIH during the conduct of the study. Dr Gibson reported receiving grants from Moderna outside the submitted work. Dr McManus reported receiving grants from the NIH and collaborative research support from CareEvolution during the conduct of the study and personal fees from Bristol Myers Squibb, Pfizer, Heart Rhythm Society, Avania Consulting, Boehringer Ingelheim, and Fitbit; grants from Bristol Myers Squibb and Pfizer; and collaborative research support from Apple outside the submitted work. No other disclosures were reported.

Funding/Support: This study was funded by grant 3U54HL143541-02S2 from the National Institutes of Health Rapid Acceleration of Diagnostics (RADx-Tech) program.

Role of the Funder/Sponsor: The funder had a role in the design and conduct of the Say Yes! Covid Test intervention but no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We are deeply grateful first to the local communities of Louisville, Kentucky; Indianapolis, Indiana; Fulton County, Georgia; O’ahu, Hawaii; Ann Arbor and Ypsilanti, Michigan; and Chattanooga, Tennessee, including local health officials, and second to our collaborators from the National Institutes of Health (NIH) National Institute of Biomedical Imaging and Bioengineering (NIBIB) and National Heart, Lung, and Blood Institute (NHLBI) who provided scientific input into the design of this study and interpretation of our results but could not formally join as co-authors owing to institutional policies. We received meaningful contributions from Bruce Tromberg, PhD; Jill Heemskerk, PhD; Andrew Weitz, PhD; and Krishna Juluru, MD (NIBIB); Rachael Fleurence, PhD (NIH Office of the Director); Felicia Qashu, PhD (NIH); and Denis Buxton, PhD; Jue Chen, PhD; and Erin Iturriaga, DNP (NHLBI). These individuals were not compensated for these contributions.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.