Over the past 2 decades, continuous quality improvement has become a focus for government agencies, with little guidance offered on how to do it. Programs that provide surgeons with data about their individual performance and how they compare with others in their region are able to truly drive change.1 Unfortunately, universal participation in national programs has not been achieved because of participation barriers. The greatest of these is cost. Solo practitioners and small groups cannot provide the capital investment to join these programs. In areas where clinicians work at multiple hospitals, additional challenges involve how the group reports quality improvement information for each hospital they cover and how to collect that information at the group level rather than the hospital level.2 The study by Hicks et al3 in this issue of JAMA Surgery is able to provide valuable information that crosses these barriers, but the article also raises numerous questions and has limitations.
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Humphries MD. Refining How We Identify High-Value Surgical Care. JAMA Surg. Published online June 12, 2019. doi:10.1001/jamasurg.2019.1737
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