Birgit Fullerton | Goethe-Universität Frankfurt am Main (original) (raw)
Papers by Birgit Fullerton
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2011
Over the last ten years changes in the legal framework of the German health care system have prom... more Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics. The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies. However, on the basis of the currently available evaluation and study results it is difficult to judge whether these develo...
International Journal of Care Coordination, 2014
on behalf of the DISMEVAL consortium Abstract Objective: To describe the interventions, research ... more on behalf of the DISMEVAL consortium Abstract Objective: To describe the interventions, research methods and main findings of the international DISMEVAL project, in which the ''real-world'' impact of exemplary European disease management approaches was investigated in six countries using advanced analytic techniques. Design: Across countries, the project captured a wide range of disease management strategies and settings; approaches to evaluation varied per country, but included, among others, difference-in-differences analysis and regression discontinuity analysis. and Spain. Participants: Health care providers and/or statutory insurance funds providing routine data from their disease management interventions, mostly retrospectively. Intervention(s): This study did not carry out an intervention but evaluated the impact of existing disease management interventions implemented in European care settings. Main outcome measure(s): Outcome measures were largely dependent on available routine data, but could concern health care structures, processes, and outcomes. Results: Data covering 10 to 36 months were gathered concerning more than 154,000 patients with three conditions. The analyses demonstrated considerable positive effects of disease management on process quality (Austria, Germany), but no more than moderate improvements in intermediate health outcomes (Austria, France, Netherlands, Spain) or disease progression (Denmark) in intervention patients, where possible compared with a matched control group. Downloaded from Conclusions: Assessing the ''real-world'' impact of chronic disease management remains a challenge. In settings where randomization is not possible and/or desirable, routine health care performance data can provide a valuable resource for practice-based evaluations using advanced analytic techniques.
Journal of Visualized Experiments, 2008
We use the whole-cell patch clamp technique to study the synaptic circuitry that underlies visual... more We use the whole-cell patch clamp technique to study the synaptic circuitry that underlies visual information processing in the retina. In this video, we will guide you through the process of performing whole-cell recordings of light evoked currents of individual cells in the retinal slice preparation. We use the aquatic tiger salamander as an animal model. We begin by describing the dissection of the eye and show how slices are mounted for electrophysiological recordings. Once the slice is placed in the recording chamber, we demonstrate how to perform whole-cell voltage clamp recordings. We then project visual stimuli onto the photoreceptors in the slice to elicit light-evoked current responses. During the recording we perfuse the slice with pharmacological agents, whereby an 8-channel perfusion system allows us to quickly switch between different agents. The retinal slice preparation is widely used for patch clamp recordings in the retina, in particular to study amacrine or bipolar cells, which are not accessible in a whole-mount preparation.
... Nolte, Ellen, Annalijn Conklin, John L. Adams, Matthias Brunn, Benjamin Cadier, Karine Chevre... more ... Nolte, Ellen, Annalijn Conklin, John L. Adams, Matthias Brunn, Benjamin Cadier, Karine Chevreul, Isabelle Durand-Zaleski, Ariannne Elissen, Antje Erler, Maria Flamm, Anne Frølich, Birgit Fullerton, Ramune Jacobsen, Cécile Knai, Robert Krohn, Boris Pöhlmann, Zuleika Saz ...
Journal of Vision, 2005
For more than a century, the process of stabilization has been a central issue in the research of... more For more than a century, the process of stabilization has been a central issue in the research of learning and memory. Namely, after a skill or memory is acquired, it must be consolidated before it becomes resistant to disruption by subsequent learning. Although it is clear that there are many cases in which learning can be disrupted, it is unclear when learning something new disrupts what has already been learned. Herein, we provide two answers to this question with the demonstration that perceptual learning of a visual stimulus disrupts or interferes with the consolidation of a previously learned visual stimulus. In this study, we trained subjects on two different hyperacuity tasks and determined whether learning of the second task disrupted that of the first. We first show that disruption of learning occurs between visual stimuli presented at the same orientation in the same retinotopic location but not for the same stimuli presented at retinotopically disparate locations or different orientations at the same location. Second, we show that disruption from stimuli in the same retinotopic location is ameliorated if the subjects wait for 1 h before training on the second task. These results indicate that disruption, at least in visual learning, is specific to features of the tasks and that a temporal delay of 1 h can stabilize visual learning. This research shows that visual learning is susceptible to disruption and elucidates the processes by which the brain can consolidate learning and thus protect what is learned from being overwritten.
Journal of Neurophysiology, 2008
BMC Health Services Research, 2013
Self-management support is a key component of effective chronic care management, yet in practice ... more Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice. We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals' views on the implementation of self-management support in practice. Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients' medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture. Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.
BMC Health Services Research, 2012
Background: To improve and assess the effectiveness of disease management programs (DMPs), it is ... more Background: To improve and assess the effectiveness of disease management programs (DMPs), it is critical to understand how many people drop out of disease management programs and why.
The Cochrane …, Jan 1, 2011
This is the protocol for a review and there is no abstract. The objectives are as follows: The p... more This is the protocol for a review and there is no abstract. The objectives are as follows:
The primary objective of this review is to assess the effects of different blood glucose treatment targets in terms of long-term complications and determine whether very low, near normoglycaemic values are of additional benefit.
Background To improve and assess the effectiveness of disease management programs (DMPs), it is ... more Background
To improve and assess the effectiveness of disease management programs (DMPs), it is critical to understand how many people drop out of disease management programs and why.
Methods
We used routine data provided by a statutory health insurance fund from the regions North Rhine, North Wurttemberg and Hesse. As part of the German DMP for type 2 diabetes, the insurance fund received regular documentation of all members participating in the program. We followed 10,989 patients who enrolled in the DMP between July 2004 and December 2005 until the end of 2007 to study how many patients dropped out of the program. Dropout was defined based on the discontinuation of program documentation on a particular patient, excluding situations in which the patient died or left the insurance fund. Predictors of dropout, assessed at the time of program enrolment, were explored using logistic regression analysis.
Results
5.5% of the patients dropped out of the disease management program within the observation period. Predictors of dropout at the time of enrolment were: region; retirement status; the number of secondary diseases; presence of a disabling secondary disease; doctor's recommendations to stop smoking or to seek nutritional counselling; and the completion and outcome of the routine foot and eye exams. Different trends of dropout were observed among retired and employed patients: retired patients of old age, who possibly drop out of the program due to other health care priorities and employed people of younger age who have not yet developed many secondary diseases, but were recommended to change their lifestyle.
Conclusions
Overall, dropout rates for the German disease management programs for type 2 diabetes were low compared to other studies. Factors assessed at the time of program enrolment were predictive of later dropout and should be further studied to provide information for future program improvements.
Zusammenfassung In den letzen zehn Jahren wurden die gesetzlichen Rahmenbedingungen des deutsche... more Zusammenfassung
In den letzen zehn Jahren wurden die gesetzlichen Rahmenbedingungen des deutschen Gesundheitssystems verändert mit dem Ziel, die Versorgung chronisch kranker Patienten durch eine Förderung innovativer Versorgungsstrukturen zu verbessern. Neue Entwicklungen beinhalteten die bundesweite Einführung von strukturierten Behandlungs- (Disease Management) Programmen (DMP), Verträge zur integrierten Versorgung, die Förderung der Einbeziehung nicht-ärztlicher Berufsgruppen in die hausärztliche Versorgung, die Einführung von Hausarztverträgen sowie die Möglichkeit der interdisziplinären Zusammenarbeit in Medizinischen Versorgungszentren (MVZ).
Ziel dieses Artikels ist es, den Stand der Umsetzung neuer Versorgungsmodelle in der gesetzlichen Krankenversicherung und die Auswirkungen auf die Versorgung chronisch Kranker in Deutschland zu beschreiben. Dazu wurde im Rahmen eines europäischen Projektes zur Entwicklung und Validierung von Methoden zur Evaluation von Disease Management Programmen (DISMEVAL) eine selektive Literaturrecherche durchgeführt, um relevante Modelle und Evaluationsstudien zu identifizieren.
Anhand vorliegender Evaluations- und Studienergebnisse kann bisher nur unzureichend bewertet werden, inwieweit diese Entwicklungen tatsächlich die Versorgungsqualität chronisch kranker Patienten in Deutschland verbessert haben. Da eine begleitende Evaluation nur für DMP gesetzlich vorgeschrieben ist, und diese darüber hinaus methodische Probleme aufweist, gibt es derzeit noch kaum belastbare Ergebnisse zum Erfolg dieser Modelle. Die Ergebnisse zum DMP beziehen sich vorwiegend auf das Programm für Diabetes mellitus Typ II und zeigen eine konsistente Verbesserung von Prozessparametern, wie z.B. die regelmäßige Durchführung von Kontrolluntersuchungen und eine leitliniengerechte Therapie, sowie eine Erhöhung der Lebensqualität von Patienten im DMP. Ob dies langfristig auch zu einer Verminderung von Folgeerkrankungen, Mortalität und Krankheitskosten führt, bedarf jedoch noch weiterer, methodisch fundierter Untersuchungen.
Summary
Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics.
The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies.
However, on the basis of the currently available evaluation and study results it is difficult to judge whether these developments have actually led to an improvement in the quality of chronic care in Germany. Only for DMPs, evaluation is legally mandatory; its methods are inappropriate, though, for studying the effectiveness of DMPs. Further study results on the effectiveness of DMPs mostly focus on the DMP Diabetes mellitus type II and show consistent improvements regarding process parameters such as regular routine examinations, adherence to treatment guidelines, and quality of life. More research will be needed to determine whether DMPs can also help reduce the incidence of secondary disease and mortality in the long term.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2011
Over the last ten years changes in the legal framework of the German health care system have prom... more Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics. The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies. However, on the basis of the currently available evaluation and study results it is difficult to judge whether these develo...
International Journal of Care Coordination, 2014
on behalf of the DISMEVAL consortium Abstract Objective: To describe the interventions, research ... more on behalf of the DISMEVAL consortium Abstract Objective: To describe the interventions, research methods and main findings of the international DISMEVAL project, in which the ''real-world'' impact of exemplary European disease management approaches was investigated in six countries using advanced analytic techniques. Design: Across countries, the project captured a wide range of disease management strategies and settings; approaches to evaluation varied per country, but included, among others, difference-in-differences analysis and regression discontinuity analysis. and Spain. Participants: Health care providers and/or statutory insurance funds providing routine data from their disease management interventions, mostly retrospectively. Intervention(s): This study did not carry out an intervention but evaluated the impact of existing disease management interventions implemented in European care settings. Main outcome measure(s): Outcome measures were largely dependent on available routine data, but could concern health care structures, processes, and outcomes. Results: Data covering 10 to 36 months were gathered concerning more than 154,000 patients with three conditions. The analyses demonstrated considerable positive effects of disease management on process quality (Austria, Germany), but no more than moderate improvements in intermediate health outcomes (Austria, France, Netherlands, Spain) or disease progression (Denmark) in intervention patients, where possible compared with a matched control group. Downloaded from Conclusions: Assessing the ''real-world'' impact of chronic disease management remains a challenge. In settings where randomization is not possible and/or desirable, routine health care performance data can provide a valuable resource for practice-based evaluations using advanced analytic techniques.
Journal of Visualized Experiments, 2008
We use the whole-cell patch clamp technique to study the synaptic circuitry that underlies visual... more We use the whole-cell patch clamp technique to study the synaptic circuitry that underlies visual information processing in the retina. In this video, we will guide you through the process of performing whole-cell recordings of light evoked currents of individual cells in the retinal slice preparation. We use the aquatic tiger salamander as an animal model. We begin by describing the dissection of the eye and show how slices are mounted for electrophysiological recordings. Once the slice is placed in the recording chamber, we demonstrate how to perform whole-cell voltage clamp recordings. We then project visual stimuli onto the photoreceptors in the slice to elicit light-evoked current responses. During the recording we perfuse the slice with pharmacological agents, whereby an 8-channel perfusion system allows us to quickly switch between different agents. The retinal slice preparation is widely used for patch clamp recordings in the retina, in particular to study amacrine or bipolar cells, which are not accessible in a whole-mount preparation.
... Nolte, Ellen, Annalijn Conklin, John L. Adams, Matthias Brunn, Benjamin Cadier, Karine Chevre... more ... Nolte, Ellen, Annalijn Conklin, John L. Adams, Matthias Brunn, Benjamin Cadier, Karine Chevreul, Isabelle Durand-Zaleski, Ariannne Elissen, Antje Erler, Maria Flamm, Anne Frølich, Birgit Fullerton, Ramune Jacobsen, Cécile Knai, Robert Krohn, Boris Pöhlmann, Zuleika Saz ...
Journal of Vision, 2005
For more than a century, the process of stabilization has been a central issue in the research of... more For more than a century, the process of stabilization has been a central issue in the research of learning and memory. Namely, after a skill or memory is acquired, it must be consolidated before it becomes resistant to disruption by subsequent learning. Although it is clear that there are many cases in which learning can be disrupted, it is unclear when learning something new disrupts what has already been learned. Herein, we provide two answers to this question with the demonstration that perceptual learning of a visual stimulus disrupts or interferes with the consolidation of a previously learned visual stimulus. In this study, we trained subjects on two different hyperacuity tasks and determined whether learning of the second task disrupted that of the first. We first show that disruption of learning occurs between visual stimuli presented at the same orientation in the same retinotopic location but not for the same stimuli presented at retinotopically disparate locations or different orientations at the same location. Second, we show that disruption from stimuli in the same retinotopic location is ameliorated if the subjects wait for 1 h before training on the second task. These results indicate that disruption, at least in visual learning, is specific to features of the tasks and that a temporal delay of 1 h can stabilize visual learning. This research shows that visual learning is susceptible to disruption and elucidates the processes by which the brain can consolidate learning and thus protect what is learned from being overwritten.
Journal of Neurophysiology, 2008
BMC Health Services Research, 2013
Self-management support is a key component of effective chronic care management, yet in practice ... more Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice. We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals' views on the implementation of self-management support in practice. Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients' medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture. Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.
BMC Health Services Research, 2012
Background: To improve and assess the effectiveness of disease management programs (DMPs), it is ... more Background: To improve and assess the effectiveness of disease management programs (DMPs), it is critical to understand how many people drop out of disease management programs and why.
The Cochrane …, Jan 1, 2011
This is the protocol for a review and there is no abstract. The objectives are as follows: The p... more This is the protocol for a review and there is no abstract. The objectives are as follows:
The primary objective of this review is to assess the effects of different blood glucose treatment targets in terms of long-term complications and determine whether very low, near normoglycaemic values are of additional benefit.
Background To improve and assess the effectiveness of disease management programs (DMPs), it is ... more Background
To improve and assess the effectiveness of disease management programs (DMPs), it is critical to understand how many people drop out of disease management programs and why.
Methods
We used routine data provided by a statutory health insurance fund from the regions North Rhine, North Wurttemberg and Hesse. As part of the German DMP for type 2 diabetes, the insurance fund received regular documentation of all members participating in the program. We followed 10,989 patients who enrolled in the DMP between July 2004 and December 2005 until the end of 2007 to study how many patients dropped out of the program. Dropout was defined based on the discontinuation of program documentation on a particular patient, excluding situations in which the patient died or left the insurance fund. Predictors of dropout, assessed at the time of program enrolment, were explored using logistic regression analysis.
Results
5.5% of the patients dropped out of the disease management program within the observation period. Predictors of dropout at the time of enrolment were: region; retirement status; the number of secondary diseases; presence of a disabling secondary disease; doctor's recommendations to stop smoking or to seek nutritional counselling; and the completion and outcome of the routine foot and eye exams. Different trends of dropout were observed among retired and employed patients: retired patients of old age, who possibly drop out of the program due to other health care priorities and employed people of younger age who have not yet developed many secondary diseases, but were recommended to change their lifestyle.
Conclusions
Overall, dropout rates for the German disease management programs for type 2 diabetes were low compared to other studies. Factors assessed at the time of program enrolment were predictive of later dropout and should be further studied to provide information for future program improvements.
Zusammenfassung In den letzen zehn Jahren wurden die gesetzlichen Rahmenbedingungen des deutsche... more Zusammenfassung
In den letzen zehn Jahren wurden die gesetzlichen Rahmenbedingungen des deutschen Gesundheitssystems verändert mit dem Ziel, die Versorgung chronisch kranker Patienten durch eine Förderung innovativer Versorgungsstrukturen zu verbessern. Neue Entwicklungen beinhalteten die bundesweite Einführung von strukturierten Behandlungs- (Disease Management) Programmen (DMP), Verträge zur integrierten Versorgung, die Förderung der Einbeziehung nicht-ärztlicher Berufsgruppen in die hausärztliche Versorgung, die Einführung von Hausarztverträgen sowie die Möglichkeit der interdisziplinären Zusammenarbeit in Medizinischen Versorgungszentren (MVZ).
Ziel dieses Artikels ist es, den Stand der Umsetzung neuer Versorgungsmodelle in der gesetzlichen Krankenversicherung und die Auswirkungen auf die Versorgung chronisch Kranker in Deutschland zu beschreiben. Dazu wurde im Rahmen eines europäischen Projektes zur Entwicklung und Validierung von Methoden zur Evaluation von Disease Management Programmen (DISMEVAL) eine selektive Literaturrecherche durchgeführt, um relevante Modelle und Evaluationsstudien zu identifizieren.
Anhand vorliegender Evaluations- und Studienergebnisse kann bisher nur unzureichend bewertet werden, inwieweit diese Entwicklungen tatsächlich die Versorgungsqualität chronisch kranker Patienten in Deutschland verbessert haben. Da eine begleitende Evaluation nur für DMP gesetzlich vorgeschrieben ist, und diese darüber hinaus methodische Probleme aufweist, gibt es derzeit noch kaum belastbare Ergebnisse zum Erfolg dieser Modelle. Die Ergebnisse zum DMP beziehen sich vorwiegend auf das Programm für Diabetes mellitus Typ II und zeigen eine konsistente Verbesserung von Prozessparametern, wie z.B. die regelmäßige Durchführung von Kontrolluntersuchungen und eine leitliniengerechte Therapie, sowie eine Erhöhung der Lebensqualität von Patienten im DMP. Ob dies langfristig auch zu einer Verminderung von Folgeerkrankungen, Mortalität und Krankheitskosten führt, bedarf jedoch noch weiterer, methodisch fundierter Untersuchungen.
Summary
Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics.
The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies.
However, on the basis of the currently available evaluation and study results it is difficult to judge whether these developments have actually led to an improvement in the quality of chronic care in Germany. Only for DMPs, evaluation is legally mandatory; its methods are inappropriate, though, for studying the effectiveness of DMPs. Further study results on the effectiveness of DMPs mostly focus on the DMP Diabetes mellitus type II and show consistent improvements regarding process parameters such as regular routine examinations, adherence to treatment guidelines, and quality of life. More research will be needed to determine whether DMPs can also help reduce the incidence of secondary disease and mortality in the long term.