Diagnostic errors pose a significant challenge in the U.S. healthcare system, particularly in rural settings. According to the Agency for Healthcare Research and Quality (AHRQ), these errors contribute to approximately 10 percent of patient deaths and 6-17 percent of hospital adverse events.4
The National Academy of Medicine (NAM) defines diagnostic errors as the failure to establish an accurate and timely explanation of the patient’s health problems or to communicate that explanation to the patient. Each year, approximately 12 million U.S. adults experience a diagnostic error, leading to as many as 80,000 deaths. These errors result in delayed, incorrect, or missed diagnoses, often causing irreversible harm and increased healthcare costs, amounting to an estimated $100 billion annually in malpractice claims.21
At the patient level, it is estimated that 33 percent of diagnostic errors result in patient injury,22 and 57 percent of these failures occur in ambulatory care,21 the predominant mode of care delivery in rural settings. Addressing diagnostic errors in rural healthcare is critical for improving patient outcomes and ensuring diagnostic excellence (timely, safe, equitable, effective, patient‐centered, and efficient care).21
Rural areas are not a smaller version of urban areas. Numerous studies highlight significant disparities in diagnostic accuracy within rural areas, primarily due to physician shortages and higher poverty rates,4,13,23,24 which are both key determinants of health outcomes.25-29 Rural areas have fewer primary care physicians (4.9 per 10,000 rural residents versus 8.0 per 10,000 urban residents) and a higher percentage of residents living below the federal poverty level (23.8% rural vs. 17.7% in urban).14
Rural status itself imposes additional disadvantages on most healthcare utilization measures, independent of poverty and healthcare supply (e.g., geographic barriers, limited access to specialty care, lower health literacy),14 which exacerbate challenges in accessing timely and accurate diagnoses.4,30
Compared with urban areas, disparities in health outcomes for patients in rural areas are vast.4 Data from a 2017 Centers for Disease Control and Prevention (CDC) report indicate that mortality rates for the top 5 causes of death in the U.S. are higher in rural areas than in urban areas. In addition, the disparities between rural and urban populations are increasing.31 Rural patients have a higher prevalence of diagnosed chronic conditions (35% rural areas vs. 26% urban areas)18 such as arthritis, diabetes,32 hepatitis, hypertension, and failing kidneys.18 Rural areas also have a larger percentage of adults over age 65 years (19% rural vs. 15% urban).33 Further, despite national efforts to reduce preventable conditions such as heart disease (14% rural vs. and 10% urban)20 and stroke (18.6% rural vs. 16.9% nonrural),34 mortality rates in rural areas decline more slowly than in urban areas. This difference is partly due to a lack of accurate preventive screening and diagnosis.5,13,20,34
Rural residents are also at a greater risk of death from frequently misdiagnosed diseases such as cancer23 and chronic respiratory disease.31 They are less likely to engage in regular physical activity, leading to a higher prevalence of overweight individuals (30% more overweight compared with urban areas).5 In addition, they are more at risk for a sedentary lifestyle (60% more compared with urban areas),5 which affects comorbidities. Rural residents are more susceptible to unintentional injury, as many work in high-risk occupations (e.g., farming, mining, forestry)30 and have a higher prevalence of behavioral and mental health disorders,35 substance use disorders, and oral health issues.13,30,36 They also face significant physical barriers to healthcare access, including transportation difficulties, rugged terrain, and limited broadband internet access, all of which hinder both in-person and remote telehealth services.13,31
Given the significant health disparities in rural America, innovative strategies are urgently needed to reduce diagnostic errors in rural healthcare settings.
