Intervention
respiratory tract infections
Peer comparison feedback was delivered in monthly email messages from practice leadership during the 18-month intervention period. We assessed clinicians’ inappropriate prescribing rates within each geographic region using electronic health record data. Clinicians ranked in the lowest decile of inappropriate prescribing rates (the top-performing decile) were told via email that they were a “top performer.” The remaining clinicians were told that they were “not a top performer.” Both types of emails included the number and proportion of antibiotic prescriptions the clinician wrote for antibiotic-inappropriate acute respiratory tract infections. Those labeled “not top performers” were also shown the proportion written by top performers. Ties in rankings were allowed so any number of clinicians could be labeled “top performers.”