Integrating AI-assisted diagnostic imaging into federally qualified health centers: A policy framework for advancing diagnostic equity in underserved U.S. communities

Abstract

Federally Qualified Health Centers (FQHCs) serve over 30 million Americans annually, the majority of whom live in medically underserved communities where access to diagnostic imaging is severely limited or entirely absent. In these populations, delayed or absent imaging drives late-stage disease presentation, preventable mortality, and escalating healthcare costs — consequences that fall disproportionately on rural communities, racial and ethnic minorities, and low-income patients for whom FQHCs represent the primary or only point of healthcare contact. AI-assisted diagnostic imaging tools, including FDA-cleared detection algorithms, portable imaging platforms, and tele-radiology systems, offer a scalable and cost-effective pathway to address this crisis. Evidence from international deployments in low-resource health systems demonstrates that these tools can achieve diagnostic accuracy comparable to specialist review, reduce time-to-diagnosis by 30–50%, and expand screening access when integrated into community-level care delivery through task-sharing and tele-radiology models. Yet despite this evidence base and despite the scale and reach of the U.S. FQHC network, no comprehensive policy framework exists for integrating AI-assisted diagnostic imaging into FQHC infrastructure at national scale. Drawing on the BRIDGE Project Diagnostic Access Intervention Logic Model and synthesized implementation evidence from low-resource health systems across 14 countries, this paper proposes a four-component policy framework for FQHC integration: infrastructure standardization, workforce task-sharing, reimbursement alignment, and federal program integration. Implementation of this framework across the U.S. FQHC network has the potential to meaningfully reduce diagnostic delays, improve early cancer detection rates, and advance the federal agenda for health equity articulated in the Cancer Moonshot Initiative and Healthy People 2030. Keywords: Federally Qualified Health Centers (FQHCs), BRIDGE Project.

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