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Hayward commented, regarding performance-measure adherence for adults, "It sounds terrible . . . that 50% of recommended care is not received, but . . . mandating adherence to these recommendations is not necessarily in the best interest of patients or society. . . . At the heart of this problem is our wish to keep efforts at quality improvement and cost containment separate."2 Benefits from guidelines are not necessarily additive,3,4 since there are usually
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