Comparison of utilization and cost among contract adult day health care, VA adult day health care, and customary care

Abstract

The contract ADHC evaluation compared the utilization and costs of patients assigned to contract ADHC with patients assigned to VA-ADHC care or customary care in the VA-ADHC evaluation. The ADHC costs per patient day were lower on average in the contract sites than in the VA-ADHC sites, although they were similar to the costs at 2 of the 4 VA-ADHCs. The contract site patients received significantly more days of ADHC care, offsetting their lower cost per day. Contract site patients had significantly fewer VA clinic visits and VA nursing home admissions than did patients in the VA-ADHC or customary care groups. Patients at the contract sites also had significantly fewer days of nursing home care than did the customary care group patients. Propensity scores based on intake characteristics were used to adjust for initial differences between the patients in the 2 evaluations. After adjustments, the total cost of care for contract ADHC patients was found to be significantly higher than the cost for customary care patients, but no significant difference was found between contract ADHC patients and VA-ADHC patients.