The structural change that occurred in the East Tallinn Central Hospital (ETCH) in 2006, according to which medical rehabilitation was separated from the current comprehensive clinic, was the biggest change for departments engaged in long-term nursing. In addition to the long-term nursing centre at Järve, the Department of Patients without Medical Insurance is also part of the Clinic. The Long-Term Nursing Centre has 90 beds divided into three inpatient departments. One of these is the Geriatric Department and the other two are nursing care departments. Patients often arrive in the Long-Term Nursing Clinic after active treatment, because they need care, stabilisation and support before returning home. The Geriatric Department cares for patients mostly over 65 years of age. People of this age may be left with permanent problems caused by illness and total recovery may not be possible. The Long-Term Nursing Clinic tries to
robust and high-quality evaluation of integrated care. This would help address the lack of evidence available to inform decisions about integrated care. Further work is needed to identify: ·the specific problems of fragmentation that integrated care initiatives seek to resolve ·the impact of integrated care on patient experience and improved processes of care ·how integration changes patterns in the use of services (especially inpatient care) ·the impact on costs and outcomes (Ramsey and Fulop, 2008). It is therefore vital that those pursuing integrated care consider how development and impact will be evaluated and measured. Evaluations of integrated care initiatives tend to focus on the processes and outcomes involved. Any such examination also needs to account for the context in which integrated care develops, and the diverse perspectives (service user, provider and so
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