Continuity, collaboration, and coordination


Older medical patients often have multiple conditions and are therefore connected to several specialties at the hospital. Around 15% of older medical patients in Denmark are readmitted within one month after discharge from hospital, some caused by fast transitions or discharges. Transitions within the hospital and across sectors are associated with loss of information and increased risk of adverse events due to lack of communication. 

Main Focus 

Our research group have obtained knowledge in the fields of: Experiences of hospital encounters and the collaboration between staff and relatives, documentation practices among nurses, collaboration between hospital and municipality regarding a new screening tool and investigating how case managing can contribute to more safe trajectories for older medical patients. Further, we study the connection between patients’ diagnoses and ward allocation and patients’ disease patterns and how they fit into existing disease management programs. 

On-going studies 

Ampur study. A retrospective population-based national registry study that includes data on demographics, diagnoses, surgery, medications, and healthcare services from five national registries. Data are retrieved from 14 years before until 1 year after the amputation. Descriptive statistics are used to describe progression of diseases and use of medication and healthcare services. The main purpose is to examine the use of medication and the number of contacts with health care services during the 14 years leading up to the lower extremity amputation (LEA), among all Danish patients that underwent LEAs in 2010 or 2011.

Lightel. A crossover study on older, frail nursing home residents. Lightel investigates the effect of LED light on confusion, sleepiness, mental state, depression, quality of life, sleep quality, Activities of Daily Living, nutrition, mobility and several clinical biomarkers. The light, which is installed at one floor of the nursing home, is regulated to imitate a summer day. The residents are exposed to the light in all common areas and in their own apartments. The residents are randomized to two groups: one is examined prior to and during LED light exposure and the other is examined during and after LED light exposure. Control subjects live are included from a different floor of the nursing home, where the LED light is not installed. The control subjects are examined during the same period as the test subjects. We are currently analyzing data.


An evaluation of nursing documentation of acutely admitted home-living older medical patients in a Danish hospital. Sivertsen, D.M., Juul-Larsen, H.G., Lawson-Smith, L., Lindhardt, T., Petersen, J., Andersen, O. Clinical Nursing Studies (2018): 6;1.

Shared regional/municipal case management for the frail older medical patient. Evaluation of geriatric case management at Gastroenterological Unit, Hvidovre Hospital. June 2016 (Report).

Info-65 across sectors. Municipal prevention of readmissions for acutely admitted older medical patients. An intersectoral implementation project between Hvidovre Hospital and the municipalities of Brøndby and Copenhagen. December 2015 (Report).

Prevalence and overlap of Disease Management Program diseases in older hospitalized patients. Juul-Larsen, H. G., Petersen, J., Sivertsen, D. M., & Andersen, O. (2017). European Journal of Ageing14(3), 283–293.

Progression of disease preceding lower extremity amputation in Denmark: a longitudinal registry study of diagnoses, use of medication and healthcare services 14 years prior to amputation (2017). Jensen PS, Petersen J, Kirketerp-Møller K, Poulsen I, Andersen O. BMJ Open. 2017.

An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation.Kristensen MT, Holm G, Krasheninnikoff M, Jensen PS, Gebuhr P (2016). Acta Orthop. 2016 Jun;87(3):306-11.

Barriers and facilitators for implementing a new screening tool in an emergency department: a qualitative study applying the Theoretical Domains Framework. Jeanette Wassar Kirk, Ditte Maria Sivertsen, Janne Petersen, Per Nielsen & Helle Vendel Petersen. J Clin Nurs. 2016 Jun 7. doi: 10.1111/jocn.13275. [Epub ahead of print]​.

Elderly Patients with Community-Acquired Pneumonia Are Not Treated According to Current Guidelines. Tove Lindhardt, Henrik Hedegaard Klausen, Christina Christiansen, Louise Lawson Smith, Janne Petersen & Ove Andersen, Dan Med J 2013;60(2):A4572.

Ældre Patienter med Pneumoni Behandles Ikke i Overensstemmelse med Aktuelle Kliniske Retningslinjer. Tove Lindhardt, Henrik Hedegaard Klausen, Christina Christiansen, Louise Lawson Smith, Janne Petersen & Ove Andersen, Ugeskr Læger 2013;175(6):360.

Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differences, in a public healthcare system. Hedegaard Klausen, H., Petersen, J., Lindhardt, T., Bandholm, T., Hendriksen, C., Kehlet, H., Vestbo, J. & Andersen, O. 2012 I : Respiratory Medicine. 106, 12, s. 1778-1787 ​