{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:05:02Z","timestamp":1776229502345,"version":"3.50.1"},"reference-count":56,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["#FBD\u2010181577"],"award-info":[{"award-number":["#FBD\u2010181577"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001804","name":"Canada Research Chairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001804","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antipsychotic medications remain widely used in nursing homes (NHs) despite guidelines discouraging potentially inappropriate use. While home\u2010level variation is known, less is understood at the unit and organization levels, or across other psychotropic and non\u2010psychotropic drugs. We examined prescribing variation across NHs in Ontario, Canada. We examined prescribing variation for psychotropic and non\u2010psychotropic drugs across NH units, homes, and organizations in Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of NH residents using EMR data from April 1, 2022, to March 31, 2023. Outcomes included whether residents were prescribed any antipsychotic, antidepressant, statins, cardiovascular disease (CVD) medications, and trazodone for at least 1\u2009day during the follow\u2010up period. Multi\u2010level logistic regression models adjusted for resident characteristics and included random intercepts for units, homes, and organizations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 16,896 NH residents across 179 homes and five organizations, 39% were prescribed antipsychotics, 65.5% antidepressants, 33% statins, 65% CVD medications, and 38% trazodone. Substantial variation was observed across all medications. For antipsychotics, the home\u2010level median odds ratio (MOR) was 1.65 (95% CrI: 1.52\u20131.78) and unit\u2010level MOR was 1.24 (95% CrI: 1.10\u20131.33). Trazodone exhibited the highest variation (home\u2010level MOR: 2.06, 95% CrI 1.75\u20132.37; unit\u2010level MOR: 1.87, 95% CrI 1.76\u20131.97). No significant variation was found at the organization level. Resident characteristics, like aggression and dementia, were associated with prescribing but did not explain unit and home\u2010level differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prescribing variation extends beyond antipsychotics to other common pharmacotherapies. Unit\u2010level variation reveals additional unexplained variation not captured in previous home\u2010level studies, providing new targets for research and quality improvement interventions. Future research should explore potential unit\u2010 and home\u2010level contributors, such as staffing, practice culture, clinician decision\u2010making, and policies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70357","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T05:09:51Z","timestamp":1771477791000},"page":"1099-1109","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variation in Psychotropic and Non\u2010Psychotropic Prescribing in Nursing Homes: A Multi\u2010Level\n                    <scp>EMR<\/scp>\n                    \u2010Based Retrospective Cohort Study"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1881-5465","authenticated-orcid":false,"given":"Darly","family":"Dash","sequence":"first","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Rahim","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Ontario Canada"},{"name":"Centre for Integrated Care St. Joseph's Health System  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry Yu\u2010Hin","family":"Siu","sequence":"additional","affiliation":[{"name":"Department of Family Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6282-3614","authenticated-orcid":false,"given":"Aaron","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Ontario Canada"},{"name":"Schlegel\u2010UW Research Institute for Aging  Waterloo Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Potter","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Division of General Internal Medicine and Geriatric Medicine Sinai Health  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophiya","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioural Neurosciences McMaster University  Hamilton Ontario Canada"},{"name":"GeriMedRisk  Waterloo Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul R.","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Medicine McMaster University  Hamilton Ontario Canada"},{"name":"Department of Geriatrics Florida State University College of Medicine  Tallahassee Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey W.","family":"Poss","sequence":"additional","affiliation":[{"name":"School of Public Health Sciences University of Waterloo  Waterloo Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George A.","family":"Heckman","sequence":"additional","affiliation":[{"name":"Lawson Research Institute, Schulich School of Medicine &amp; Dentistry Western University  London Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew P.","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University  Hamilton Ontario Canada"},{"name":"Centre for Integrated Care St. Joseph's Health System  Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.70.5.485"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.7.676"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.2232"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.469"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4098"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/2040622316658463"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0706743716673321"},{"issue":"1","key":"e_1_2_13_9_1","first-page":"17","article-title":"Deprescribing Antipsychotics for Behavioural and Psychological Symptoms of Dementia and Insomnia","volume":"64","author":"Bjerre L. 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