Diagnostic Excellence in U.S. Rural Healthcare: A Call to Action

Rural America, home to approximately 60 million people (1 in every 5 patients)¹ in the United States (U.S.), faces distinct healthcare challenges that critically impact the accuracy and timeliness of medical diagnoses.^2-4 These challenges include limited resources (e.g., availability of healthcare services, workforce, infrastructure) and geographic isolation, which contribute to an elevated risk of diagnostic errors,⁵ such as delayed treatments and misdiagnoses, and can lead to poorer health outcomes and increased healthcare costs.^2,4,6 

According to the Census Bureau, rural areas are defined as those with fewer than 2,000 housing units or 5,000 residents.^7,8 Small rural hospitals make up 30 percent of all U.S. hospitals⁹ and are vital in providing care services to approximately 59 million residents (20% of the population).^8-10 

Rural healthcare delivery encounters significant obstacles that increase the risk of diagnostic errors,^11-13 such as limited access to advanced diagnostic tools, a shortage of specialists, and substantial social determinants of health (SDOH) affecting patients.^2,4,13,14 Rural healthcare entities also struggle with financial viability,¹² limiting their ability to invest in new diagnostic technologies and training programs.¹² A national survey of 474 administrators in Critical Access Hospitals (25 beds or fewer in rural areas) indicated that financial constraints, staff shortages, and outdated technology significantly hinder the implementation of patient safety interventions.^11,15 

A 2020 Centers for Medicare & Medicaid Services (CMS) report, Examining Rural Hospital Bypass for Inpatient Services, detailed numerous factors leading to rural hospital avoidance. These include quality concerns and poor reputation,¹⁶ indicating that when initial care is established with a physician at another nonrural hospital, patients are less likely to return to the rural facility for care.¹⁷ Thus, high-quality patient care, including optimal diagnostic care, is crucial for retaining patients within local rural communities¹⁶ and the viability of rural care delivery organizations themselves (e.g., hospitals, clinics). These factors, among numerous others, collectively contribute to delays in diagnosing life-threatening conditions in rural patients with complex comorbidities.^18-20 

Despite significant challenges, interested parties in rural healthcare (e.g., hospitals, clinics, individual providers, and community health organizations) remain steadfast in their commitment to delivering high-quality patient care. 

This issue brief explores several critical challenges affecting diagnostic excellence in U.S. rural healthcare settings, emphasizing the need to address these impediments, and proposes three actionable strategies to overcome barriers to delivering high-quality diagnostic care in these areas. The three areas of focus where rural diagnostic patient care can be immediately advanced are: 

1. Enhancing specialty care and surgical service lines.
2. Strengthening care coordination.
3. Screening for social determinants of health.

These ideas guide this call to action, contributing to ongoing efforts to improve diagnostic outcomes in rural healthcare settings, recognizing the complexity of these challenges, and acknowledging the potential for meaningful progress in advancing rural patient safety, quality, and equity.