These real-world multicomponent interventions responding to physician pay-for-performance (P4P) incentives were associated with substantial reductions in antibiotic prescriptions for acute respiratory tract infections (ARTIs) in 2 safety-net health systems without unintended harms.

Among 3,583 consecutive patients with ARTIs, mean antibiotic prescribing rates for ARTIs decreased from 35.9% to 22.9% at LAC+USC and from 48.7% to 27.3% at OV-UCLA after the intervention.

HEDIS-inappropriate prescribing rates decreased from 28.9% to 19.7% at LAC+USC and from 40.9% to 12.5% at OV-UCLA.

There was no evidence of unintended consequences.

A nonrandomized intervention (5/28/2015-2/1/2018) was conducted at 2 large academic safety-net hospitals: Los Angeles County+University of Southern California (LAC+USC) and Olive View-UCLA (OV-UCLA).

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