UC Davis Health is using artificial intelligence (AI) to improve the quality of colonoscopy procedures, better track how doctors are performing and reduce patients’ risk of developing colorectal cancer.

Colonoscopies are a key tool in preventing colon cancer because they allow physicians to detect and remove precancerous polyps before they become cancerous. While increasing access to screening is important, the quality of each procedure is just as critical.

“Not all colonoscopies are equal,” said Juan Carlos Garcia, medical director of gastroenterology clinical services at UC Davis Health. “The goal isn’t just to perform a colonoscopy, but to perform a high-quality colonoscopy that detects precancerous lesions early.”

One of the most important measures of colonoscopy quality is the adenoma detection rate (ADR). ADR represents the percentage of procedures in which a physician finds adenomas, a common type of precancerous polyp.

Research shows that for every 1% increase in physician’s adenoma detection rate, their patient’s risk of developing colorectal cancer after a colonoscopy drops by about 3% and dying from colorectal cancer by approximately 5%.

“The data clearly shows that early detection leads to better outcomes,” Garcia said. “Our goal is to identify areas for improvement and make sure patients receive the highest-quality care possible.”

Closing gaps in data with AI

Until recently, accurately tracking ADR required manual data entry. After each colonoscopy, pathologists had to manually flag findings such as tubular adenomas in the electronic medical record. This extra step sometimes led to missing or incomplete data, making consistent performance measurement difficult.

To address this challenge, gastroenterologists at UC Davis Health implemented an AI-supported tool within Epic, the health system’s electronic medical record. The tool automatically analyzes pathology reports and identifies the number of detected adenomatous polyps. By removing the need for manual input, the system produces more accurate, complete and reliable data.

“This tool allows us to measure performance in real time. It ensures nothing is missed and gives us a more accurate picture of how well we are doing — as individual physicians and as an institution.”—Juan Carlos Garcia

“This tool allows us to measure performance in real time,” Garcia said. “It ensures nothing is missed and gives us a more accurate picture of how well we are doing — as individual physicians and as an institution.”

Clinical and patient benefits

The tool is designed to support quality improvement. Physicians can view their own detection rates and compare them with national benchmarks and department averages. When a physician’s detection rates fall under approved benchmarks, the department works collaboratively to identify opportunities for improvement. These may include changes to technique, withdrawal time or equipment, while taking into consideration patient factors such as age and cancer risk.

For patients, higher-quality colonoscopies mean a lower chance of developing colon cancer after a screening. 

“As an academic medical center, we are always advancing care through research and innovations,” explained Garcia. “This tool improves patient safety and helps generate insights that can improve care.”

Looking ahead

Garcia expects similar tools to become increasingly important as health systems, insurers and referring providers place greater emphasis on quality measures when guiding patient care.

“When even one patient falls through the cracks, the human cost is enormous,” added Garcia. “Using tools like this helps ensure fewer patients ever reach that point.”