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A few commenters expressed concerns about removing structural measures as clinical-based measures do not incentivize actionable change at the systemic level, citing measure gaming, or demonstrating improvements on measures that are disconnected from true improvements in patient care, as a reason to maintain these measures

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Am J Prev Med

This was demonstrated previously by Takashima and colleagues who revealed a decrease in the abundance of gut colonising Clostridiales in mice following PPI administration (Takashima et al