Assessing and improving the quality of surgical care in rural America.

The quality of surgical care in rural hospitals is important, as surgery remains a critical component of rural health care systems. Current models for surgical quality assessment and improvement largely reflect the characteristics of larger urban hospital settings, which include proximity to other providers for peer review, higher procedure volumes to accurately assess outcomes, and greater financial resources to acquire data collection systems and finance participation in regional or national quality improvement programs, such as the American College of Surgeons National Surgical Quality Improvement Program. Although rural surgeons and hospitals face numerous challenges in their efforts to demonstrate or improve the quality of their surgical practices, developments in surgical quality favor their increased participation in quality improvement initiatives.