title: Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector.
abstract: BACKGROUND
  Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers.
  
  
  METHODS
  An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers' knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared.
  
  
  RESULTS
  The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer's costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers.
  
  
  CONCLUSIONS
  Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.
authors.affiliation: Body@Work, Research Center for Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, the Netherlands. j.m.van.dongen@vu.nl
authors.forename: Johanna M
authors.initials: JM
authors.lastname: van Dongen
authors.forename: Emile
authors.initials: E
authors.lastname: Tompa
authors.forename: Laurie
authors.initials: L
authors.lastname: Clune
authors.forename: Anna
authors.initials: A
authors.lastname: Sarnocinska-Hart
authors.forename: Paulien M
authors.initials: PM
authors.lastname: Bongers
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
authors.forename: Allard J
authors.initials: AJ
authors.lastname: van der Beek
authors.forename: Marieke F
authors.initials: MF
authors.lastname: van Wier
mesh_terms: D000068:Accreditation; D003365:Costs and Cost Analysis; D003657:Decision Making; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine / Q000191:economics; D005260:Female; D005381:Financing, Organized; D019981:Health Care Sector / Q000191:economics*; D006276:Health Facility Size; D006801:Humans; D033181:Information Dissemination; D007400:Interprofessional Relations; D008297:Male; D008485:Medical Audit; D016272:Occupational Health / Q000191:economics*; D009864:Ontario; D036301:Qualitative Research