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Patient admission to homecare is a complex process. Medicare policy requires that all patients receive a first home visit within 48 hr after the referral is received at the homecare agency. For unstable or high risk patients, waiting 48 hr to be seen by homecare nurses may not be safe. In this pilot study we tested an innovative clinical decision support tool (called PREVENT), designed to identify patients who may need to be prioritized for early homecare visits. The study was conducted in 2016 at a large homecare agency in the Northeastern US with 176 patients admitted to homecare from the hospital. In the control phase (n = 90 patients), we calculated the PREVENT priority score (indicative of high or medium/low first nursing visit priority) but did not share the score with the homecare intake nurses who influence visit scheduling. In the experimental phase, the PREVENT score was shared with the homecare intake nurses (n = 86 patients). During the experimental phase, high-risk patients received their first homecare nursing visit about one-half a day sooner than in the control phase (1.8 days vs. 2.2 days). Rehospitalizations from homecare decreased by 9.4% between the control (21.1%) and experimental phases (11.7%). This pilot study of patient prioritization showed promising results: high priority patients received their first homecare visit sooner and overall rehospitalization rates were lower.

We investigate here the effects of the incorporation of the nucleoside analogs araC (1-L L-D-arabinofuranosylcytosine) and ganciclovir (9-[(1,3-dihydroxy-2-propoxy)methyl] guanine) into the DNA binding recognition sequence for the GATA-1 erythroid transcription factor. A 10-fold decrease in binding affinity was observed for the ganciclovir-substituted DNA complex in comparison to an unmodified DNA of the same sequence composition. AraC substitution did not result in any changes in binding affinity. I H-IS N HSQC and NOESY NMR experiments revealed a number of chemical shift changes in both DNA and protein in the ganciclovir-modified DNA-protein complex when compared to the unmodified DNA-protein complex. These changes in chemical shift and binding affinity suggest a change in the binding mode of the complex when ganciclovir is incorporated into the GATA DNA binding site.z 1999 Federation of European Biochemical Societies.

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