Pay for performance programs cut antibiotic prescriptions at safety-net hospitals

Real-world physician pay-for-performance (P4P) multicomponent interventions are associated with a significant reduction in antibiotic prescriptions for acute respiratory tract infections (ARTIs) at safety-net hospitals, according to a study published online June 12 in the American Journal of Managed Care.

Richard K. Leuchter, M.D., from the David Geffen School of Medicine at University of California, Los Angeles (UCLA), and colleagues conducted a nonrandomized intervention at two large academic safety-net hospitals: Los Angeles County+University of Southern California (LAC+USC) and Olive View-UCLA (OV-UCLA) to examine the effects of P4P-motivated interventions to reduce antibiotic prescriptions. Five staggered Choosing Wisely-based interventions were launched in combination (audit and feedback, clinician education, suggested alternatives, procalcitonin, and public commitment) for safety-net patients with ARTIs.

The researchers found that the mean antibiotic prescribing rate decreased among 3,583 consecutive patients with ARTIs: from 35.9 to 22.9 percent at LAC+USC and from 48.7 to 27.3 percent at OV-UCLA after the intervention (adjusted odds ratios, 0.60 and 0.81, respectively). There were decreases in Healthcare Effectiveness Data and Information Set-inappropriate prescribing rates from 28.9 to 19.7 percent at LAC+USC and from 40.9 to 12.5 percent at OV-UCLA (adjusted odds ratios, 0.69 and 0.72, respectively). No evidence of unintended consequences was seen.

"This study provides real-world evidence that these types of behavioral interventions can reduce antibiotic overuse in less-well resourced patients without causing unintended harm such as decreased appropriate antibiotic use," Leuchter said in a statement.

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