EFFECTS OF CONTRACT ADULT DAY HEALTH-CARE ON HEALTH OUTCOMES AND SATISFACTION WITH CARE

The second phase of the ADHC Evaluation Study was designed to assess A DHC provided under contract by community ADHC programs. Outcomes for t he 163 patients enrolled in this prospective cohort evaluation were co mpared with those of patients assigned to ADHC provided directly by VA (VA-ADHC) and customary care in the randomized trial phase of the stu dy. In spite of identical admission criteria, contract ADHC patients w ere significantly different from VA-ADHC and customary care patients o n several characteristics and were more impaired in health status at s tudy intake. They were also more impaired in physical health status at 12 months, even after controlling for base-line differences. There we re no significant differences in any other patient or care giver healt h outcomes. Contract ADHC patients were more satisfied than customary care patients in nursing homes (but not more satisfied than patients i n home care), whereas VA-ADHC patients were more satisfied than those in contract ADHC. It is suggested that differences in physical functio n are due to differences in patient health status at intake rather tha n a detrimental effect of contract ADHC.