Created in 2006 to provide healthcare and social support to dependent patients in Portugal, the National Integrated Continued Care Network (NICCN) has been unable to tackle a growing demand, as the population ages with high dependency indices and social resources are scarce.
The study involved a retrospective cohort study of adult patients referred to the NICCN by a Portuguese university hospital in 2022, with sociodemographic and clinical characterization of patients and analysis of the referral process, outcomes and one-year survival after referral.
A total of 916 patients were referred but only 579 were admitted. Patients referred by the Palliative Care Department (PCD, n = 100) were younger and 64% had a cancer diagnosis, compared to 8% of patients referred by the Senior Management Team (n = 816), among whom stroke and trauma prevailed. The median time from referral to acceptance was 5 days for patients referred by PCD and 14 days for others. One-third of referrals were rejected/cancelled and 50% of corresponding patients died within a year, as did 35% of those admitted to the NICCN. Most patients referred by PCD died within 4 months of referral, 47% of them before admission to the NICCN.
The referral process to the NICCN is time-consuming and many patients die or are discharged while waiting for a place. The high proportion of deaths within the first year after referral and within a few months for patients referred by the PCD suggests that the NICCN as a whole could benefit from a specialised palliative care intervention, which should take place earlier.
Apart from estimates on the number of vacancies in NICCN and waiting time trends, no previous research evaluated the outcomes and efficiency of this process.
