We thank Gruneir and Lapane for their letter and agree with them that our research raises important questions about the factors behind the variations in the use of antipsychiotic agents across NHs. Our work suggests that patient factors cannot fully explain the observed differences in use at the facility level. Grunier and Lapane raise the issue of organizational culture as a key determinant of facility-level variation, and we agree that further work on factors that shape this culture are important in both understanding and improving how care is provided to the frail elderly population in NHs. We are currently working with the provincial government and NHs in Ontario, Canada, to develop a collaborative and coordinated strategy for creating a broader culture for NH safety and a safer environment for NH residents.
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