Trajectory and outcomes of patients referred from a Portuguese university hospital to the national integrated continued care network: retrospective study

Purpose 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. Design/methodology/approach 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. Findings 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. Practical implications 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. Originality/value 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.