Facilitating ultrasound utilization for diagnosis of abdominal pain in rural children

The National Institute for Minority Health and Health Disparities awarded Research Institute At Nationwide Children's Hospital $446,046 on July 1, 2026, under the Minority Health and Health Disparities Research program (CFDA 93.307) to increase ultrasound utilization for diagnosis of abdominal pain in rural children.

The research addresses disparities in diagnostic imaging access among the 13 million children living in rural areas, where computed tomography is overused due to limited ultrasound availability, increasing imaging costs, radiation exposure, and cancer risk. The project will simulate the reach and effectiveness of three ultrasound utilization models to increase ultrasound use and decrease radiation exposure for children evaluated with abdominal pain. Research will identify patient, facility, and area-level contextual factors associated with variable ultrasound use among low-income children in rural Appalachian communities, and will employ qualitative methods to identify caregiver and organizational-level factors influencing ultrasound utilization at community hospitals in Appalachia. The work is guided by the Practical Implementation Sustainability Model and RE-AIM implementation framework.

Work is performed in Columbus, Ohio. The period of performance extends from July 1, 2026, through June 30, 2028.

Abstract

Rural populations have decreased access to diagnostic ultrasound, which provides a low-cost and radiation­free method for evaluating abdominal pain in children. As a result, many children are evaluated with computed tomography, which increases imaging costs, radiation exposure, and cancer risks. This lack of access to appropriate imaging exacerbates the existing widespread disparities in health outcomes among the 13 million children who live in rural areas. This disparity in imaging practices has been noted nationally for over a decade without successful implementation of a solution. The long-term objective of this research is to increase access to ultrasound for diagnostic imaging for underserved children in rural areas, thereby increasing the quality, safety, and value of care. This research will provide insights for a national approach to increase ultrasound utilization and then focus specifically on appalachia, an economically distressed region where the urban-rural divide in healthcare access is particularly striking. The aims of the research will be guided by the practical implementation sustainability model (PRISM)/reach, effectiveness, adoption, implementation, and maintenance (RE-aim) implementation framework, adapted to the specific overarching goal of this research. Aim 1 will simulate the reach and effectiveness of three ultrasound utilization models to increase ultrasound utilization and decrease radiation exposure for children evaluated with abdominal pain. Aim 2 will identify patient, facility, and area-level contextual factors that are associated with variable ultrasound use among low­income children in rural appalachian communities. Aim 3 will use qualitative methods to identify caregiver and organizational-level contextual factors that influence ultrasound utilization for rural children at community hospitals in appalachia. These aims will define the underlying causes of imaging disparities in rural children, guide selection of the best approach to improve access to guideline-adherent imaging, and develop a feasible and acceptable implementation strategy to increase ultrasound utilization for rural children. This study will also develop children's hospital/community hospital partnerships through which an evidence-based implementation approach to reduce imaging-related disparities in rural areas can be tested in future work.