U.S. rural healthcare is often perceived through a lens of lack—limited resources, limited funding, limited technology. However, healthcare is still being delivered in rural settings despite these limitations, and a path to diagnostic excellence is possible within the constraints of rurality, as numerous entities (e.g., federal and state governments, hospital associations, patient safety and quality improvement organizations) support efforts to advance rural healthcare.
Achieving diagnostic excellence in rural healthcare requires coordinated and sustained actions from policymakers, healthcare providers, healthcare organizations, community members, patients, and other interested parties. By leveraging available funding sources and implementing targeted interventions in the short and long term, it is possible to reduce diagnostic errors, improve patient safety, and enhance the quality of care for rural patients. Such efforts can focus on the following groups.
Policymakers. Policymakers could consider prioritizing funding and support for rural healthcare initiatives focused on:
- Enhancing diagnostic services.
- Improving community and patient engagement.
- Implementing comprehensive care coordination strategies.
- Including strategies to address social determinants of health in financial incentive plans.
Policymakers could consider further supporting and expanding funding for rural healthcare initiatives focused on diagnostic services and specialty care service lines, ensuring that rural populations have equitable access to high-quality diagnostic care and technology.
Policymakers can recognize that applying for grants, the primary mode for a funding acquisition in rural healthcare settings, requires substantial organizational resources, staff time, and clinical expertise. These may not be available in rural hospitals, and application programs may want to consider addressing this barrier. Simplifying the grant application process or introducing alternative methods (e.g., streamlined applications, technical assistance programs) to facilitate funding access for rural hospitals can have an exponential impact in bridging the rural-urban diagnostic divide. Reducing award turnaround time to ensure funding is accessible in a more immediate manner can also help.
Further, refining approaches to improving the value of healthcare delivery is needed as prevalent alternative payment models (e.g., value-based payment models,89 global budgets90,91) do not capture diagnostic accuracy or measure diagnostic errors. This measurement is indispensable because benchmarking data are a cornerstone of longitudinal quality improvement.
Policies, strategies, and funding could also include the development of regionalized rural healthcare networks, identifying zones where connections can be enabled, or where research is necessary, and investing in those areas.41
Healthcare Providers. Rural healthcare providers (e.g., physicians, nurse practitioners, laboratory, and pharmacy technicians) can use evidence-based diagnostic tools and embrace best practices by joining specialty tele-networks among regional providers. If such networks do not exist, clinicians can form peer networks. Providers can also use and locally adapt existing patient safety and quality diagnostic resources to help improve patient outcomes. Such resources include health information exchanges, telemedicine services (e.g., remote ECG interpretation), and standardized screening protocols (e.g., SDOH screening tools).25,74,92,93
Providers can also adjust care, or help address unmet social needs, through referrals. Ensuring that patients have access to culturally and linguistically appropriate services (e.g., having interpreter services available) can improve accuracy of descriptions and discussions related to symptoms or medical history.94 Rural clinicians can access numerable publicly available patient safety improvement toolkits and resources from organizations such as AHRQ (e.g., TeamSTEPPS for Diagnosis Improvement Course, Toolkit for Engaging Patients To Improve Diagnostic Safety),95-97 the American Hospital Association rural-specific toolkits (e.g., Get With the Guidelines®),98 and the Institute for Healthcare Improvement (e.g., Optimizing a Business Case for Safe Health Care: An Integrated Approach to Safety and Finance).99,100
Individual clinicians in rural areas are encouraged to engage in continuous education and training to stay abreast on the latest diagnostic techniques and error prevention strategies. Where feasible, they should incorporate modalities such as point-of-care ultrasound, wearable technologies, and new biomarker or genetic testing (e.g., multicancer early detection screening). Integrating these practices into routines can enhance diagnostic accuracy and timeliness, positively impacting patient outcomes.
Healthcare Organizations. Hospitals can seek grant funding to adopt advanced diagnostic technologies and implement telemedicine and hybrid care models that enhance diagnostic accuracy and reduce delays. In addition, organizations can use a variety of grant funding sources to invest in continuous quality improvement strategies to ensure that high-quality care is consistently delivered across all service lines.50,101-103
Organizations can also address social determinants of health by incorporating screening tools, connecting patients with local organizations and resources, and providing culturally and linguistically appropriate care (e.g., on-hand interpreter services to improve medical history or symptom discussions).26 Care coordination agreements and fostering regional, inclusive healthcare networks of care delivery providers can also support this goal.71,72
Patients. Patients can be empowered to actively participate in their healthcare by understanding their conditions,97,100 recognizing symptoms that require medical attention, and engaging in health education initiatives. These include participating in health screenings, asking clarifying questions at the point of care, and engaging with health literacy content. This patient enabling enhances the accuracy and timeliness of diagnoses, contributing to better diagnostic outcomes.
Communities. Healthcare providers and organizations can enhance patient engagement by fostering community involvement through culturally appropriate health education campaigns. Initiatives such as health fairs and local workshops aim to improve health literacy, promote regular screenings for early detection of health conditions, and ultimately lead to more accurate and timely diagnoses. Interested parties in communities—including patients, local organizations, and advocacy groups—are essential in driving these efforts and ensuring their success. Communities can also advocate for beneficial healthcare policies at the state and federal level to ensure that rural healthcare systems receive the support and resources needed to achieve diagnostic excellence.
To achieve diagnostic excellence in rural healthcare, interested parties must work together to implement evidence-based tools and embrace technological advancements to address the unique challenges of rurality. Focusing on diagnostic accuracy and timeliness has immense potential to enhance patient health outcomes, minimize diagnostic errors, and bridge the critically widening gap in patient safety and quality between rural and urban healthcare settings. By continuously refining and standardizing best practices, rural healthcare can deliver high-quality, safe, equitable, and timely care, setting a new standard for diagnostic excellence in even the most underserved rural communities.
