Data collection
depression, pain
In this pragmatic trial, we used provincial health administrative data to assess baseline characteristics and outcomes. Data were compiled from (1) the Ontario Drug Benefits database, which covers nearly all prescriptions in nursing homes; (2) the Canadian Institute for Health Information databases covering all inpatient hospitalizations and emergency department visits; (3) the Ontario Health Insurance Plan database, covering physician billings; (4) the Registered Persons Database covering demographic information; and (5) the Continuing Care Reporting System database for clinical and demographic information on nursing home residents collected using the Resident Assessment Instrument (RAI). A full RAI assessment completed by nursing home staff is legislatively mandated within 14 days of admission and updated annually or with a change in status; a quarterly RAI assessment is required every 92 days. RAI data were used to identify dates of admission and discharge to define the appropriate set of residents contributing to each time period. For each 3-month period under investigation, residents were assigned to a most responsible physician according to previously defined algorithms [We used the RAI for demographic and clinical characteristics of residents, including clinical assessment scores (e.g., function scale, pain scale, depression rating score, aggressive behaviour score). We used Ontario Health Insurance Plan data to determine whether residents had a specialist consultation in the prior year by a geriatrician or psychiatrist. We used the Canadian Institute for Health Information datasets to assess whether residents had an emergency department visit in the prior year (using the National Ambulatory Care Reporting System database) and whether residents had a hospital admission in the prior year (using the Discharge Abstract Database). These databases provide complete population-level data for the variables of interest.