The need to compare outcomes across hospitals is of paramount importance to our patients, physicians, and payers. Administrative databases are inherently limited in scope as has been described in several recent articles in this and other journals.1 To date, the National Surgical Quality Improvement Program (NSQIP) remains the most robust risk-adjusted and reliable tool available and, most important, the only tool that is readily accepted by most surgeons. A significant problem with NSQIP is that its expense limits the number of participating hospitals and excludes most of our smaller and rural hospitals—hospitals about which one might legitimately wish to ask certain quality and safety questions.
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