Rural communities across the United States face ongoing barriers to timely and accurate diagnosis — from limited specialty services and long travel distances to gaps in broadband and workforce capacity. Duke’s Occupational Therapy Doctorate (OTD) program, in partnership with faculty members in Orthopaedic Surgery, Pediatrics, and Population Health Sciences, is helping change this situation. Associate Professor Emily M. D’Agostino, DPH, MS, MeD, MA (Orthopaedic Surgery; Duke Clinical Research Institute), who directs Community-Engaged Research Practice in the OTD Division, recently contributed to a National Academies of Sciences, Engineering, and Medicine initiative focused on improving diagnosis in rural areas, emphasizing practical, equity-centered strategies that OTD learners can implement in real-world practice.
“Improving diagnosis in rural communities requires more than technology — it demands genuine community partnerships and adaptable care models that meet people where they are,” says D’Agostino. “Through the Duke OTD program, we’re training clinicians to lead these efforts and develop sustainable solutions for health equity.”
Why Rural Diagnosis Needs a Different Approach
The National Academies’ workshop on Advancing Diagnostic Excellence in Rural Areas highlighted several priorities: reducing access barriers, enhancing patient-centered communication, and utilizing telehealth, mobile units, and AI-powered tools to support clinicians across large geographic areas in serving communities. It also focused on interprofessional education to minimize diagnostic delays and adaptable strategies for other underserved settings. These themes align with the OTD program’s mission to prepare practitioners who understand both clinical complexity and the social determinants of health that influence diagnostic journeys.
D’Agostino’s perspective offers an epidemiologist’s view of orthopaedic and rehabilitation care. Her team’s work demonstrates how distance, transportation, and provider shortages exacerbate diagnostic challenges—showing how community-centered solutions can bridge these gaps. For example, D’Agostino is a PI on an innovative national ARPA-H program in partnership with Mission Mobile Medical, which is developing EV mobile medical clinics to provide hospital-level care, including imaging, lab services, and specialty consultations, directly to rural communities—models that improve triage and early detection while reducing downstream costs and complications.
Her scholarly work—including studies on COVID-19 testing and treatment access, youth physical activity and resilience, and transportation equity—shows how data and community partnerships can reveal missed opportunities for earlier detection, risk assessment, and ongoing care in populations often underrepresented in research. These findings inform OTD coursework and mentorship, giving students practical tools to turn evidence into practice.
Bringing Care to Patients: Mobile, Telehealth, and Hybrid Models
A key insight from the National Academies workshop is that rural diagnostic excellence relies on meeting patients and communities where they are—physically, socially, and digitally. For Duke OTD students, this means learning to incorporate mobile health units, telehealth, and remote diagnostics into routine care to ensure accessibility for patients with limited broadband or device access. It also involves designing workflows that consider social factors, trust, and ways to connect patients to primary care, specialty services, and community resources without disrupting the patient experience.
D’Agostino’s work showcases what this looks like practically: mobile clinics that shorten evaluation times, reduce non-emergency emergency department visits, and improve continuity by bringing follow-up and education directly to the patient’s community. Also important, these clinics are being co-designed with communities from across the nation to ensure that they are responsive to patients’ needs. When combined with OTD’s training in occupation-centered interventions and environmental modifications, these models help patients move from diagnosis to meaningful participation in daily life—sooner and with fewer disruptions.
Education That Reduces Diagnostic Delay
Delays in diagnosis in rural areas often stem from system constraints and communication gaps. The workshop highlighted professional development that trains clinicians to recognize atypical presentations, use shared decision-making, and coordinate across disciplines—skills central to the OTD curriculum. Duke OTD’s courses on assembling, creating, and translating knowledge (courses OTD 505 and 512) give students hands-on experience applying mixed methods to answer research questions that address health disparities and enhance clinical reasoning, storytelling with patients, and information sharing among care teams.
The key message for students: diagnostic excellence is not a single test or tool—it’s a process rooted in listening, understanding context, and collaboration. By combining occupational therapy frameworks with population health approaches, Duke OTD graduates are well equipped to lead initiatives that reduce missed or delayed diagnoses and improve outcomes across rural counties.
Impact Beyond the Classroom
D’Agostino’s work—with the Duke Clinical Research Institute, the Duke Global Health Institute, and local community partnerships—illustrates how OTD-trained leaders can operate at the crossroads of clinical care, policy, and implementation science. For current and future OTD students, the message is clear: the skills gained at Duke prepare you to build systems that are timely, equitable, and patient-centered—whether deploying mobile diagnostics after a storm, managing telehealth for remote follow-up, or redesigning care pathways for county health networks.