title: Integrating qualitative research methods into care improvement efforts within a learning health system: addressing antibiotic overuse.
abstract: BACKGROUND
  Despite reports advocating for integration of research into healthcare delivery, scant literature exists describing how this can be accomplished. Examples highlighting application of qualitative research methods embedded into a healthcare system are particularly needed. This article describes the process and value of embedding qualitative research as the second phase of an explanatory, sequential, mixed methods study to improve antibiotic stewardship for acute sinusitis.
  
  
  METHODS
  Purposive sampling of providers for in-depth interviews improved understanding of unwarranted antibiotic prescribing and elicited stakeholder recommendations for improvement. Qualitative data collection, transcription and constant comparative analyses occurred iteratively.
  
  
  RESULTS
  Emerging themes and sub-themes identified primary drivers of unwarranted antibiotic prescribing patterns and recommendations for improving practice. These findings informed the design of a health system intervention to improve antibiotic stewardship for acute sinusitis. Core components of the intervention are also described.
  
  
  CONCLUSIONS
  Qualitative research can be effectively applied in learning healthcare systems to elucidate quantitative results and inform improvement efforts.
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America. corrine.e.munoz-plaza@kp.org.
authors.forename: Corrine E
authors.initials: CE
authors.lastname: Munoz-Plaza
authors.affiliation: Patient Centered Outcomes Research Institute, Washington, DC, 20036, United States of America.
authors.forename: Carla
authors.initials: C
authors.lastname: Parry
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Hahn
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America.
authors.forename: Tania
authors.initials: T
authors.lastname: Tang
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America.
authors.forename: Huong Q
authors.initials: HQ
authors.lastname: Nguyen
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gould
authors.affiliation: Quality and Clinical Analysis, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kanter
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, United States of America.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Sharp
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D032882:Comprehension; D003695:Delivery of Health Care / Q000592:standards; D017144:Focus Groups; D006266:Health Education; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007858:Learning; D000069342:Medical Overuse; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D058996:Quality Improvement; D011787:Quality of Health Care; D012107:Research Design; D012852:Sinusitis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute sinusitis; Antibiotics; Embedded research; Guidelines; Mixed methods; Qualitative research