Diabetic eye disease (DED) is a leading cause of blindness in the world. Annual DED testing is recommended for adults with diabetes, but adherence to this guideline has historically been low. In 2020, Johns Hopkins Medicine (JHM) began deploying autonomous AI for DED testing. In this study, we aimed to determine whether autonomous AI implementation was associated with increased adherence to annual DED testing, and how this differed across patient populations. JHM primary care sites were categorized as “non-AI” (no autonomous AI deployment) or “AI-switched” (autonomous AI deployment by 2021). We conducted a propensity score weighting analysis to compare change in adherence rates from 2019 to 2021 between non-AI and AI-switched sites. Our study included all adult patients with diabetes (>17,000) managed within JHM and has three major findings. First, AI-switched sites experienced a 7.6 percentage point greater increase in DED testing than non-AI sites from 2019 to 2021 (p < 0.001). Second, the adherence rate for Black/African Americans increased by 12.2 percentage points within AI-switched sites but decreased by 0.6% points within non-AI sites (p < 0.001), suggesting that autonomous AI deployment improved access to retinal evaluation for historically disadvantaged populations. Third, autonomous AI is associated with improved health equity, e.g. the adherence rate gap between Asian Americans and Black/African Americans shrank from 15.6% in 2019 to 3.5% in 2021. In summary, our results from real-world deployment in a large integrated healthcare system suggest that autonomous AI is associated with improvement in overall DED testing adherence, patient access, and health equity.

糖尿病眼病（DED）是世界上导致失明的主要原因。建议成人糖尿病患者每年进行一次 DED 检测，但历史上对该指南的遵守率很低。 2020 年，约翰霍普金斯医学院 (JHM) 开始部署自主人工智能进行 DED 测试。在这项研究中，我们的目的是确定自主人工智能的实施是否与增加每年 DED 测试的依从性相关，以及这在不同患者群体中有何不同。 JHM 初级保健站点被归类为“非 AI”（无自主 AI 部署）或“AI 切换”（到 2021 年实现自主 AI 部署）。我们进行了倾向得分加权分析，以比较 2019 年至 2021 年非人工智能和人工智能转换网站之间的遵守率变化。我们的研究涵盖了 JHM 管理的所有成年糖尿病患者（>17,000 名），并得出了三项主要发现。首先，从 2019 年到 2021 年，AI 切换站点的 DED 测试增幅比非 AI 站点高 7.6 个百分点 ( p < 0.001)。其次，黑人/非裔美国人在 AI 切换网站中的遵守率增加了 12.2 个百分点，但在非 AI 网站中下降了 0.6 个百分点 ( p < 0.001)，这表明自主 AI 部署改善了历史上处于不利地位的人获得视网膜评估的机会人口。第三，自主人工智能与改善健康公平相关，例如亚裔美国人和黑人/非裔美国人之间的依从率差距从 2019 年的 15.6% 缩小到 2021 年的 3.5%。总而言之，我们在大型综合应用中的实际部署结果医疗保健系统表明，自主人工智能与整体 DED 测试依从性、患者可及性和健康公平性的改善相关。