Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 THE REFERENCE SITE COLLABORATIVE NETWORK OF THE EUROPEAN INNOVATION PARTNERSHIP ON ACTIVE AND HEALTHY AGEING Bousquet J 1, 2*, Illario M 3*, Farrell J 4 *, Batey N 5, Carriazo AM 6, Malva J 7, Hajjam J 8, Colgan E 9, Guldemond N 10, Perälä-Heape M 11, Onorato GL 1, Bedbrook A 1, Leonardini L 12, Stroetman V 13, Birov S 13, Abreu C 14, Abrunhosa A 15, Agrimi A 16, Alalääkkölä T 17, Allegretti N 18, Alonso-Trujillo F 19, Álvarez-Benito M 6, Angioli S 20, Apóstolo J 14, Armitage G 21, Arnavielhe S 22, Baena-Parejo MI 6, Bamidis PD 23, Balenović A 24 , Barbolini M 25, Baroni I 26, Blain H 27, 28, Bernard PL 29, Bersani M 30, Berti E 31, Bogatyrchuk L 32, Bourret R 33 , Brehm J 34, Brussino L 35, Buhr D 36, Bultje D 37, Cabeza E 38, Cano A 39, 40, De Capitani C 41, Carantoña E 42, Cardoso A 14, Coll Clavero JI 43, Combe B 44, Conforti D 45, Coppola L 46, Corti F 47, Coscioni E 48, Costa E 49, Crooks G 50, Cunha A 51, Daien C 44, Dantas 52, Darpón Sierra J 53, Davoli M 54, Dedeu Baraldes A 55, De Luca V 56, De Nardi L 57, Di Ciano M 58, Dozet A 59, Ekinci B 60, Erve S 8, Espinoza Almendro JM 6, Fait A 61, Fensli R 62, Fernandez Nocelo S 63, Gálvez-Daza P 64, Gámez-Payá J 40 , García Sáez M 19, Garcia Sanchez I 65, Gemicioğlu B 66, Goetzke W 34, Goossens E 67, Geurdens M 68, Gütter Z 69, Hansen H 70, Hartman S 71, Hegendörfer G 72, Heikka H 17, Henderson D 73, Héran D 74, Hirvonen S 75, Iaccarino G 76, Jansson N 77, Kallasvaara H 78, Kalyoncu F 79, Kirchmayer U 54, Kokko JA 80, Korpelainen J 81, Kostka T 82, Kuna P 83, Lajarín Ortega T 84, Lama CM 6, Laune D 22, Lauri D 85, Ledroit V 86, Levato G 87, Lewis L 88, Liotta G 89, Lundgren L 90 , Lupiañez-Villanueva F 91, Mc Garry P 92, Maggio M 93, Manuel de Keenoy E 94, Martinez C 95, Martínez - Domene M 64, Martínez-Lozano Aranaga B 96, Massimilliano M 97, Maurizio A 98, Mayora O 99, Melle C 100, Mendez-Zorilla A 101, Mengon H 45, Mercier G 102, Mercier J 103, Meyer I 100, Millet Pi-Figueras A 104, Mitsias P 105 , Molloy DW 106, Monti R 35, Moro ML 31, Muranko H 107, Nalin M 26, Nobili A 108, Noguès M 109, O’Caoimh R 106, 110, Pais S 111, Papini D 31, Parkkila P 81, Pattichis C 112, Pavlickova A 113, Peiponen A 114, Pereira S 115, Pépin JL 116, Piera Jiménez J 117, Portheine P 118, Potel L 119, Pozzi AC 120, Quiñonez P 19, 64, Ramirez Lauritsen X 121 , Ramos MJ 122, Rännäli-Kontturi A 123, Risino A 124, Robalo-Cordeiro C 125, Rolla G 35, Roller R 126, Romano M 26, Romano V 127, Ruiz-Fernández J 6, Saccavini C 128, Sachinopoulou A 129, Sánchez Rubio MJ 64, Santos L 130 , Scalvini S 131, Scopetani E 132, Smedberg D 133, Solana-Lara R 6, Sołtysik B 82, Sorlini M 119, Stericker S 134, Stramba Badiale M 135, Taillieu I 136, Tervahauta M 137, Teixeira A 138, Tikanmäki H 139, Todo-Bom A 125, Tooley A 115, Tuulonen A 140, Tziraki C 141, 142, Ussai S 143, Van der Veen S 144, Venchiarutti A 145, Verdoy-Berastegi D 94 , Verissimo M 125, Visconti L 146, Vollenbroek-Hutten M 147, Weinzerl K 148, Wozniak L 149, Yorgancıoğlu A 150 , Zavagli V 151, Zurkuhlen AJ 34 *The first three authors contributed equally to the paper 1 MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France. 2 VIMA, INSERM U 1168, VIMA : Ageing and chronic diseases. Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France, Euforea, Brussels, Belgium, and Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany 3 Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET) Naples, Italy. 4 LANUA International Healthcare Consultancy, Down, UK. 5 EIPonAHA Reference Site Collaborative network, Head of EU & International Funding, Health and Social Services Group, Welsh Government, Cardiff, UK. 6 Regional Ministry of Health of Andalusia, Seville, Spain. 7 Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra; Coimbra, and Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal. 8 CENTICH Mutualité Française Anjou Mayenne, Angers, France 9 Department of Health, Social Services and Public Safety , Northern Ireland Belfast, UK. 10 Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands 11 Oulu University, Faculty of Medicine, Oulu, Finland. 12 Veneto Region, Mattone Internazionale Program, Italy. 13 Empirica Communication and Technology Research, Bonn, Germany. 14 Nursing School of Coimbra, Ageing@Coimbra, Coimbra, Portugal 15 Comissão de Coordenação e Desenvolvimento Regional do Centro (CCDRC), Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal. 16 Aprulia Region - Research, Innovation and Capacity Building department, Bari – Italy 17 Oulu Health Labs, Oulu, Finland. 18 LISPA , Milano, Italy. Università degli Studi di Salerno 66 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 19 Agency for Social Services and Dependency of Andalusia, Seville, Spain. 20 Campania Councillor for European Funds, Euromediterranean Basin and Youth Policies, Naples, Italy 21 Newcastle University, Operations Director, National Innovation Centre for Ageing, New Castle, UK. 22 Kyomed , Montpellier France. 23 Medical Education Informatics; Lab of Medical Physics; Medical School; Aristotle University of Thessaloniki, Greece. 24 Health Care Center Zagreb, City of Zagreb, AHA Reference site, Zagreb, Croatia. 25 Regione Emilia Romagna - Agenzia Sanitaria e Sociale, Regional Health and Social Agency Emilia-Romagna, Reference Site of the European Innovation Partnership on Healthy and Active Ageing, Bologna, Italy, and EU Commission Senior Public Health Expert 26 Telbios SRL, Milan, Italy. 27 Department of Geriatrics, Montpellier University Hospital, Montpellier, France. 28 EUROMOV. EA 2991, Euromov, University of Montpellier, France. 29 Sport Faculty, University of Montpellier, France. 30 Head Unit Plans and Projects; DG Welfare – Region of Lombardy, Milano (Italy). 31 Regional Health and Social Agency Emilia-Romagna, Bologna, Italy. 32 The medical improving center "Elbrus”, Zhytomir, Ukraine. 33 Centre Hospitalier Valenciennes, France. 34 Health region CologneBonn, Köln, Germany 35 Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy. 36 University of Tuebingen / Steinbeis Transfercenter for Social and Technological Innovation, Tuebingen, Germany. 37 Healthy Ageing Network Northern Netherlands, Groningen, The Netherlands. 38 Cap de Servei de Promoció de la Salut, Direcció General de Salut Pública i Participació, Palma de Mallorca, Spain. 39 Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Spain. 40 INCLIVA, Valencia, Spain 41 Lombardy Cluster Technologies for Living Environments, Lecco (LC), Italy 42 Consejería de Presidencia y Participación Ciudadana, Oviedo, Spain. 43 Innovation and new technologies, Hospital de Barbastro Servicio Aragones de Salud Aragon, Spain. 44 Department of Rheumotology, University Hospital, Montpellier, France. 45 Autonomous Province of Trento, Health and Social Solidarity Department & TrentinoSalute4.0, Trento,Italy 46 Head Unit Health Promotion and Screening; DG Welfare – Region of Lombardy, Milan, Italy. 47 FIMMG, Federazione Italiana Medici di Medicina Generale, Milan, Italy. 48 Department of Heart Surgery, San Giovanni di Dio e Ruggi d’Aragona Hospital, Salerno, Italy 49 UCIBIO, REQUIMTE, Faculty of Pharmacy of University of Porto, Porto4ageing Reference Site, University of Porto, PORTO, Portugal. 50 Scottish Centre for Telehealth and Telecare, NHS 24, Glasgow, UK. 51 Instituto Pedro Nunes, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal. 52 Cáritas Diocesana de Coimbra, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal. 53 Regional Minister of Health , Basque Region, Bilbao, Spain. 54 Department of Epidemiology, ASL Roma 1, Lazio Regional Health Service, Roma, Italy. 55 Agency for Health Quality & Assessment of Catalonia of the Ministry of Health of Catalonia – AquAs, Barcelona, Spain 56 R&D Unit, Federico II University Hospital, Naples, Italy. 57 Health Information System International Projects, Lombardia Informatica SpA, Milano, Italy 58 InnovaPuglia - Inhouse ICT company of Regione Puglia and Reference Site Puglia WI-FI Management, Bari, Italy. 59 Health economist, Region Skåne, Sweden. 60 Head Chronic Disease Department, Ministry of Health, Ankara, Turkey. 61 Health and Social Care Directorate, ATS Città Metropolitana (Health and Social Care Agency), Milano, Italy 62 Centre of eHealth and Health Care Technology, University of Agder, Faculty of Engineering and Science, Grimstad, Norway. 63 Galician Health Knowledge Agency (ACIS), Regional Ministry of Public Health of Galicia. 64 Regional Ministry of Equality and Social Policies of Andalusia, Seville, Spain. 65 ADVANTAGE JA, SERMAS Hospital de Getafe, Spain 66 Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey. 67 Center for Gastrology, School of Gastrologic Sciences and Primary Food Care, Leuven, Belgium. Università degli Studi di Salerno 67 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 68 Center of Expertise in Primary Food Care, Center for Research and Innovation in Care (CRIC), Antwerp, Belgium. 69 University Hospital Olomouc - NTMC, National eHealth Centre, Olomouc, Czech Republic. 70 EU Consultant & Project Manager, South Denmark European Office, Brussels, Belgium. 71 Department of Social Services and Health Care, Business Development, HELSINGIN KAUPUNKI, City of Helsinki, Finland. 72 Saxony Liaison Office Brussels, Brussels, Belgium. 73 Head of European Engagement, NHS 24, Glasgow, UK. 74 CARSAT, Montpellier, France. 75 City of Oulu, Oulu, Finland. 76 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. 77 Network Ecosystem, BusinessOulu, Oulu, Finland 78 Helsinki-Uusimaa Regional Council, Helsinki, Finland. 79 Hacettepe University, School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Ankara, Turkey. 80 Department of Healthcare and Social Welfare, Technology Specialist, Oulu, Finland. 81 Oulu University Hospital OYS, Hospital District, Oulu, Finland. 82 Department of Geriatrics, Medical University of Lodz, Healthy Ageing Research Centre (HARC), Lodz, Poland. 83 Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland. 84 Committee of Representatives of People with disabilities and their Families, Region de Murcia, Spain 85 CMMC, Milano, Italy 86 Alsace Lorraine Champagne Ardenne, Bureau Europe Grand Est, Bruxelles, Belgique. 87 SIFMED, Scuola Italiana Di Formazione E Ricerca In Medicina Di Famiglia, Milan, Italy. 88 Head of Research and Development, International Foundation for Integrated Care and EIP on AHA B3 Action Group Chair, Wolfson College, Oxford, UK 89 Biomedicine and Prevention Department, University of Rome Tor Vergata, Rome, Italy 90 Development Department, Region Norrbotten, Sweden 91 Information and Communication Sciences, Universitat Oberta de Catalunya, Spain. 92 Greater Manchester Ageing Hub, Greater Manchester Combined Authority, Manchester, UK 93 Department of Medicine and Surgery - Geriatric Clinic Unit Department of Medicine Geriatric Rehabilitation, University Hospital of Parma, Italy. 94 Kronikgune, International Centre of Excellence in Chronicity Research, Barakaldo, Bizkaia, Spain 95 Costa Cálida Cares-Senior Tourism and Services, Region de Murcia, Spain 96 Regional Health Ministry, Region de Murcia, Spain 97 Financial Range for Innovation, Research, International care and health sector; Friuli Venezia Giulia Autonomous Region, Central Directorate for Health, Social Health Integration, Social Policies and Family, Trieste, Italy. 98 Plans and Projects Unit, DG Welfare – Region of Lombardy, Italy 99 Bruno Kessler Foundation, eHealth Unit and TrentinoSalute4.0, Trento, Italy 100 Care Management Unit, Hausach, Gesundes Kinzigtal GmbH, Kizingtal, Germany. 101 University of Deusto, Bilbao, Spain. 102 Unité Médico-Economie, Département de l’Information Médicale, University Hospital, Montpellier, France 103 Department of Physiology, CHRU, University Montpellier, PhyMedExp, INSERM U1046, CNRS UMR 9214, France. 104 Centre de Vida Independent CVI, Barcelona, Spain. 105 Department of Neurology, School of Medicine, University of Crete, Heraklion, Crete, Greece. 106 Centre for Gerontology and Rehabilitation, School of Medicine, UCC @ St Finbarr's Hospital, Cork, Ireland. 107 GEWI Institute, Regional Innovation Partnership on Active and Healthy Ageing, Köln, Germany 108 Mario Negri Institute for Pharmacological Research, IRCCS; Clinical Pharmacology, Geriatrics, Internal Medicine, Milano, Italy. 109 Palavas, Occitanie, France. 110 Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland. 111 Center for Biomedical Research-CBMR, Department of Biomedical Sciences and Medicine, International Center on Ageing- CENIE, University of Algarve, Portugal. 112 Dept of Computer Science, University of Cyprus, Cyprus, Greece. 113 European Service Development Manager, NHS 24, Glasgow, UK. 114 Social services and health care division, Hospital, rehabilitation and care services, Southern service district, City of Helsinki, FINLAND Università degli Studi di Salerno 68 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 115 University of Porto and Porto4Ageing Reference Site, Porto, Portugal. 116 Université Grenoble Alpes, Laboratoire HP2, Grenoble, INSERM, U1042 and CHU de Grenoble, France. 117 Information and R&D Officer, Badalona Serveis Assistencials, Badalona, Spain. 118 Coöperatie Slimmer Leven, Eindhoven, The Netherlands. 119 International Affairs & Public Procurement of Innovation, Hospital Procurement Network, Paris, France. 120 IML, Lombardy Medical Initiative, Bergamo, Italy. 121 ZealandDenmark, EU Health and Care affaires, Copenhagen , Denmark 122 UCIBIO, REQUIMTE, Faculty of Sciences of University of Porto and Porto4Ageing Reference Site, Porto, Portugal. 123 International Affairs, OuluHealth, Oulu, Finland. 124 Health Innovation Manchester, Manchester, UK 125 Faculty of Medicine, University of Coimbra, Portugal, Ageing@Coimbra EIP-AHA Reference Site. 126 Medical University of Graz, Department of Internal Medicine, Graz, Austria. 127 IRES - Institute for Economic and Social Research - Piedmont, Torino, Italy. 128 Arsenàl.IT, Veneto's Research Centre for eHealth Innovation, Venice, Italy. 129 Oulu University, Center of Health and Technology, Oulu, Finland. 130 Odem dos Farmacêuticos, Secção Regional do Centro, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal. 131 Cardiology Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane, Brescia, Italy. 132 Tuscany Region, Directorate Citizenship rights and social cohesion, Firenze, Italy 133 RISE Research Institutes of Sweden, Division Safety and Transport - Measurement Science and Technology, Lund, Sweden. 134 Head of Programmes, Yorkshire & Humber Academic Health Science Network, Wakefield, UK 135 Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milano, Italy. 136 Coördinator Zorgeconomie, Fabrieken voor de Toekomst, Brugge, Belgium 137 Social and Health Services, Kuopio, Finland. 138 Faculty of Sport Sciences and Physical Education, University of Coimbra, Ageing@Coimbra EIP-AHA Reference Site, Portugal. 139 Life Science Industries and Company Networks, BusinessOulu, Oulu, Finland 140 Tays Eye Centre, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland. 141 Research and Evaluation Department, Municipality of Jérusalem, Israël. 142 Medicine and Health Care Science, Allilegi Community Based Organization for AD and Active Healthy Aging, Heraklion, Crete, Heraklion-Crete Reference Site Region, Greece. 143 DG Welfare, Lombardy Region, Italy. 144 Department of Med Hum, Amsterdam University Medical Centers, VU University, NL. 145 Friuli Venezia Giulia Autonomous Region, Central Directorate for Health, Social Health Integration, Social Policies and Family, Trieste, Italy. 146 LifeTechValley, Life Sciences Incubator BioVille, Diepenbeek, Belgium. 147 University of Twente, Biomedical systems and signal group/telemedicine, Twente, The Netherlands. 148 Human.technology Styria GmbH, Graz, Austria 149 Research and International Relations, Department of Structural Biology, Medical University of Lodz, Lodz, Poland. 150 Celal Bayar University, School of Medicine , Department of Pulmonology, Manisa, Turkey. 151 ANT Foundation, Bologna, Italy. models, while at the same time supporting the action Abstract groups in their work. The RSCN aspires to be recognized Seventy four Reference Sites of the European Innovation by the EU Commission as the principal forum and Partnership on Active and Healthy Ageing (EIP on AHA) authority representing all EIP on AHA Reference Sites. have been recognised by the European Commission in The RSCN will contribute to achieve the goals of the EIP 2016 for their commitment to excellence in investing and on AHA by improving health and care outcomes for scaling up innovative solutions for active and healthy citizens across Europe, and the development of sustainable ageing. The Reference Site Collaborative Network economic growth and the creation of jobs. (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Abbreviations Reference Sites into a single forum. The overarching goals AHA: active and healthy ageing are to promote cooperation, share and transfer good EIP: European Innovation Partnership EIP on AHA: European Innovation Partnership on Active and practice and solutions in the development and scaling up Healthy Ageing of health and care strategies, policies and service delivery EU: European Union Università degli Studi di Salerno 69 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 EC: European Commission government authorities, cities, hospitals/care RS: Reference Site organisations, industry, SMEs and/or start-ups, research RSCN: Reference Site Collaborative Network and innovation organisations including universities and civil society), that jointly implement a comprehensive, Key words innovation-based approach to AHA, and can give evidence Active and healthy ageing, European Innovation and concrete illustrations of the impact of such approaches Partnership on Active and Healthy Ageing, EIP on AHA, on the ground" (https://ec.europa.eu/eip/ageing/reference- DG CONNECT, DG Santé sites_en). In 2012, 32 RS were awarded by the EU. Networking is a I. INTRODUCTION fundamental part of the EIP on AHA. RSs are pioneering together some of the most advanced innovative solutions As populations continue to grow older it is important to to improve the lives of its ageing populations and through support the process of ageing well, active and healthy, that the partnership. Through “maturity assessment”, referred is a priority objective [1]. The broad concept of active and to the extent to which the local ecosystem for AHA is healthy ageing (AHA) is the process of optimizing [7- opportunities for health and social care to increase healthy developed, integrated and established, joint projects 14,15,16,17,18] life expectancy, healthy life years and quality of life for all , meetings [3,11,19-22], scaling up activities [23], people as they age [2,3]. AHA allows people to realize their conferences and workshops (www.whinn.dk and potential for physical, social and mental wellbeing https://syddansksundhedsinnovationeipaha.wordpress.com throughout the life course [4]. AHA also contributes to the /news/ and sustainability of our health and social systems, reducing http://www.southdenmark.be/media/1701/dacob- dependency and disability. upscaling-workshops-introduktion.pdf) and study-visits To tackle the potential and challenges of ageing in the EU, (http://www.syddansksundhedsinnovation.dk/service- the EC - within its Innovation Union policy- launched the menu/aktuelt/2016/juli-dec2016/500-gaester-fra-20- European Innovation Partnership on Active and Healthy forskellige-lande-besoegte-syddansk-sundhedsinnovation- Ageing (EIP on AHA) [5,6] in 2012. It continues to pursue a i-2016/) collaboration has allowed RS to share good triple win for Europe practices and build cross border activities in a way that (https://webgate.ec.europa.eu/eipaha/): maximizes outcomes and reduces risks associated to • Enabling EU citizens to lead healthy, active and investing in innovation to deliver a holistic approach to the independent lives while ageing. achievement of the EIP on AHA objectives. • Improving the sustainability and efficiency of social and Revised criteria were introduced in 2016 to define and health care systems. evaluate the RS (http://ec.europa.eu/research/innovation- • Boosting and improving the competitiveness of the union/pdf/active-healthy-ageing/2016_call_rs.pdf). One of markets for innovative products and services, responding the cornerstones within this was the requirement for the to the ageing challenge.. RS to build, and demonstrate that cross sectoral The EIP on AHA brings together public and private coalitions/alliances/partnerships have been implemented at stakeholders to accelerate the deployment of major regional level which support the research, development innovations by committing them to undertaking supply and adoption of new solutions and enable the scaling up and demand side measures across sectors and the entire and transferability of good practices within their region. innovation chain. EIP on AHA does not replace existing Seventy four RSs have been recognised in 2016 for their decision-making processes. However, regional commitment to excellence in investing and scaling up commitments to EIP on AHA can influence and inform innovative digital solutions for AHA (Table 1). Together policy decisions, support change management strategies the 74 RSs have committed to invest over € 4 billion in the and service delivery models, and therefore identify next three years in the deployment and scaling up of opportunities, and potential partners, under a range of digital innovation for AHA. This investment is expected to funding programmes for the development of evidence benefit over 5 million people in the next 3 years. It will based innovative solutions. also lay the foundations for a scalable EU market for The EIP on AHA is a distinctive opportunity to help digital innovation services and products meeting the needs deliver on the policy objectives of the Europe 2020 of Europe's ageing population and their carers. flagships. Its objectives and approach are also in line with Cumulatively, the RS commit to invest in specific main the principles and goals of the EU Health Strategy areas of digital innovation: "Together for Health". • Health promotion through personalised coaching and citizens empowerment; II. REFERENCE SITES OF THE EUROPEAN • Disease prevention through big data and risk stratification; INNOVATION PARTNERSHIP ON ACTIVE AND • Digitally-enabled platforms for chronic disease HEALTHY AGEING management; • Tools for integrating hospital care and community/social Reference Sites (RS) are "ecosystems which comprise care; various players (including regional and/or local • Programmes for upgrading tele-health and tele-care Università degli Studi di Salerno 70 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 solutions to support independent living and quality of life The EB determines the strategies and actions of the of the ageing population; RSCN. It will identify specific thematic Working Groups • Multidisciplinary education, training and life-long learning aimed at producing common operational projects in innovative programs. support of the EIP on AHA objectives. The Secretariat of the RSCN will inform RS of new policy (Table 1. List and contacts of Reference Sites) and funding developments; co-ordination of twinning and knowledge sharing events; establishing and maintaining III. REFERENCE SITE COLLABORATIVE NETWORK links with candidate RS and Regions, the EU institutions and other organisations supporting EIP on AHA. The It is beneficial to contribute to a continuous and Secretariat shall be agreed and appointed by the EB. The constructive dialogue among the RS. Such a dialogue secretariat is currently based in Montpellier (MACVIA takes place participating in a collaborative network on an France go.rscn@outlook.com) equal basis, regardless of their political and administrative structure. The Reference Site Collaborative Network D. Membership (RSCN) brings together all EIP on AHA regions given RS There are 5 categories of RSCN members (Table 3). status by the EC, and Candidate RS into a single forum. All RS are full members of the RSCN and one of their representatives will be a voting member at the GA. This A. Vision representative will sit on the RSCN GA and will act on The RSCN aspires to be continually recognised by the EC behalf of all the stakeholder organisations within the RS as the principal forum and authority representing all EIP and ensure their views are represented. They will also be on AHA RS, and to establish connections with and across responsible for disseminating communications from the the Actions Groups (AG) in order to promote AHA. Our RSCN within their RS. vision is to help our members accelerate the development, (Table 3. RSCN Membership categories) deployment and adoption of innovative health and social care solutions, proven AHA delivery models and digital IV. CURRENT ACTIONS solutions that provide real impact and contribute towards sustainability of services. A. Transfer of innovation: Twinning support scheme The 2016 Transfer of Innovation Twinning Support B. Strategy Scheme was a pilot scheme launched by the EC with the The overarching goals of the RSCN are to promote support of the ScaleAHA Team (http://www.scale- cooperation, share and transfer good practice in the aha.eu/home.html) to support regional deployment of implementationand scaling up of health and care innovation by partners of the EIP on AHA through the strategies, policies and service delivery models. More reimbursement of expenses incurred in the transfer of specifically the RSCN will: innovative practices. Under this scheme, twenty pairs of  Facilitate members to develop, share and adopt good RS (Table 4) have been provided with financial support practice and innovative solutions and technologies at for study visits between experts in the adopting and scale; originator organisations. Twinning project represents an  Influence and provide strategic input to bodies such as opportunity for both patients and healthcare professionals, the EC, WHO, building on the knowledge and cause it facilitate the assessment of impact of digitally expertise of our regional members; enabled innovations in a uniform way.  Provide thought leadership through expert working (Table 4. List of Twinnings) groups;  Provide a range of advisory and management services MThe first results are promising, and the process should to members. be further refined taking into consideration lessons learnt and recommendations by the pilot twinning organisations. C. Governance The final report Reference Sites have elected an RSCN Executive Board (http://www.scaleaha.eu/fileadmin/scaleaha/documents/sc (EB) composed 8 Strategic Members and 2 Full Members aleaha_d5.4_finalstudyreport.pdf) presents interim results appointed by the General Assembly (GA). All RS are of the twinning activities, which include discussions about eligible to participate in the GA, and one vote is allocated barriers and challenges faced, success factors leveraged, to each RS when conducting business. The EB has plans and strategies on moving forward, and appointed two co- Chairs, two Deputy Vice Chairs and a recommendations for the future. It also presented twinning Treasurer (Table 2). archetypes (Figure 1). (Table 2. RSCN Executive Baord) (Figure 1. Twinning archetypes) EB Members are elected for 3 years and may be re-elected for one additional term. No Member may serve more than The ScaleAHA team also provided a number of 2 consecutive terms. The EB meets at least twice per year. recommendations coming from the RS and the twinning Università degli Studi di Salerno 71 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 activities for policy makers, and for better organisation of D. Interactions with the other EU Organisations future initiatives such as a second call for transfer of The RSCN recognizes the benefit to be achieved from innovation. Other recommendations concerned future calls working closely with other EU networks and partners, for RS, funding utilization support and the assessment of particularly those whose aims, and goals overlap with its impact of digitally enabled innovations in a uniform way. own. Nick Batey (RSCN) connects the work of the RSCN with that of EUREGHA. The RSCN also works with the ECHAlliance as part of the Coalition of the Willing B. Interactions with the Commission (CoW). The RSCN is registered at the EC Transparency Register (ID: 583454420450-89) since January 2016. The E. Current RSCN involvement in EC projects Transparency Register has been set up to answer core The RSCN is currently (December 2018) involved in three questions such as what interests are being pursued, by European Projects. VIGOUR, a 3rd Health Programme whom and with what budgets. The system is operated project, seeks to support care authorities in progressing the jointly by the European Parliament and the EC. The RSCN transformation of their health and care systems to provide is a member of the eHealth Stakeholder Group (eHSG), set sustainable models for integrated care. up by DG SANTE and DG CNECT through a call for DigitalHealthEurope, a H2020 CSA project, will provide expression of interest in January 2016. Currently comprehensive, centralized support to the digital Andalusia (representing RSCN as its vice-chair) is transformation of health and care (DTHC) priorities of the rapporteur for the working group on Care Continuum Digital Single Market. The project will support large-scale within the eHSG. RSCN is responding to public deployment of digital solutions for person-centered consultations and contributing to the decision-making integrated care. EURIPHI, also a H2020 CSA project, has process at the EC level. as its vision to build out around the Most Economic Advantageous Tender (MEAT) Value Based Procurement C. Interactions with the CSA framework which will be made accessible with adaptions The WE4AHA Coordination and Support Action (CSA is necessary to support the cross-border PPI leading to aimed at advancing the effective, large-scale uptake and “MEAT Value Based PPI”. impact of Digital Innovation for AHA, mobilizing relevant The inclusion of the RSCN in these projects highlights the stakeholders to help develop and implement three EU strategic position of the organisation within the guided activities: Innovation 2 Market, Blueprint on consortiums, acting as a catalyst to foster scaling-up across Digital Transformation of Health and Care for the Ageing regions and countries. With the RSCN, the projects have Society, and EIP on AHA. Hence, the RSCN has a first-hand access not only to regions which are innovation bidirectional connection with the CSA: is supported by the leaders, but also to regions who are less mature in their CSA for some specific horizontal activities and ensures person-centred integrated care. The RSCN closely support that the EU guided activities are developed by taking tasks related to identifying best practices by helping to advantage of the contributions of all partners of the EIP on assess the characteristics and the impact of the innovative AHA. approach. It will facilitate partnerships with other regions Within the WE4AHA CSA, the RSCN will be responsible for the updating of existing guidance material, the for some actions: conduction of twinning activities and wider scaling-up 1. Twinning programs for large scale-up digital solutions; guidance. 2. Organize at least 6 thematic workshops including: The RSCN is aiming at answering to the need for a a. Health Tourism Brussels, 27 February 2018): collaborative approach to facilitate joint reflection and leader: PROMIS, action in sharing and transferring best practices in the b. POLLAR (CoP 2019), development and scaling up of health and care strategies, c. Thematic workshops in collaboration with policies and service delivery models. EUREGHA, d. A call will be opened each year to obtain topics IV. SOME EXAMPLES OF RSCN ACHIEVEMENTS and locations from RS members. Part of funding will be available for these events; A. Programma Mattone Internazionale Salute 1. 3. Support for event of regional stakeholders to be Established in 2013 as a project of the MoH in 2016, replicated across the EU; Programma Mattone Internazionale Salute (ProMIS) 2. 4. Help to launch the next call for RS; became an institutional structure aimed at creating a 3. 5. Identification of the key elements to map the quadruple permanent dialogue and synergies among Italian Regions, helix ecosystem;. as well as with the EU health policies and systems. 4. 6. Evaluation of RS progress; ProMIS provides opportunities of information and 5. 7. Release content for dissemination activities. discussion, organizing workshops and conferences, satisfying the needs jointly expressed by Italian regions. It also disseminates European calls, stimulating the participation of Italian clusters to the consortia and Università degli Studi di Salerno 72 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 supporting the regions in the coordination for the TLR9) [29-35] to other RSs [36]. MASK follows the criteria participation to the calls. The program has developed for Good Practices of the CHRODIS Joint Action [37] and preparatory activities to support the Regions in their its privacy is in line with the Article 28 EU General Data application to become a RS and to submit commitments, Protection Regulation (EU-GDPR) [38]. The phenotypic explaining the details of the calls, facilitating the access to characteristics of rhinitis and asthma multimorbidity [39] in the useful information in order to prepare the proposal, adults and the elderly are compared using validated thus making the Italian Regions collaborate at their best information and communication technology (ICT) tools with the other European Regions [24]. Among the 74 RSs (i.e. the Allergy Diary and CARAT: Control of Allergic awarded by the EC in 2016, 11 are Italian Regions that Rhinitis and Asthma Test) in 29 RSs, regions or countries have been assigned one or more stars according to the across Europe and beyond. This will improve maturity: Campania, Emilia Romagna, Friuli Venezia understanding, assessment of burden, diagnosis and Giulia, Lazio, Liguria, Lombardy, Piedmont, Puglia, management of rhinitis in the elderly by comparison with Tuscany, Veneto and the Autonomous Province of Trento. an adult population. Specific objectives are to: (i) assess In order to define a common RS “model” and give the percentage of adults and elderly who are able to use Regions a structure to assess the effectiveness/validity of the Allergy Diary, (ii) study phenotypic characteristics and their strategies, Italian Regions agreed to draft a document treatment over a period of one year of rhinitis and asthma “Methodology for the Italian Reference Sites: Which multimorbidity at baseline (cross-sectional study) and (iii) organizational structure?” where RS management, follow-up using visual analogue scale (VAS). This part of methods and tools are described, supported by validation the study may provide some insight into the differences elements of the RS model at European level. Every year between the elderly and adults in terms of response to the updated version of "EIP-AHA Italy: the Italian treatment and practice as well as precision medicine [40]. experience in the framework of the European Innovation Finally (iv) work productivity is examined in adults. The Partnership on Active and Healthy Ageing" is also first results of MASK@Twinning are very promising and published, which is the focal document describing Italian over 400 patients have been recruited. A pilot study RS activity and all the relevant European and national showed that the questionnaire for physicians (EUFOREA- initiatives linked with EIP-AHA. ARIA website, www.euforea.eu/) [40] is appropriate. This project also allowed MASK to be deployed in the entire country with the national society in France and Germany. B. Global Alliance Chronic Respiratory Diseases Moreover, MASK@Twinning has been endorsed by the Regional Network (Turkey) European Academy of Allergy and Clinical Immunology The Global Alliance Chronic Respiratory Diseases (EAACI), the European Respiratory Society (ERS), the Regional Network is the National Control Program of International Primary Care Airways Group (IPCRG), two Turkish MoH on chronic airway disease with 64 major European patients’ organisations (EFA, European collaborating parties which can be used as a model for EIP Federation of Allergy and Airways Diseases Patients’ on AHA RS [25,26]. Associations and ELF, European Lung Foundation) and an international patient’s organization (GAAP) [41] . It is C. Coimbra activities of the RSCN WHO Global Alliance against Chronic Respiratory Instituto Pedro Nunes, a member of Ageing@Coimbra Diseases (GARD) demonstration project. reference site, was the local organizer of the Ambient MASK@Twinning centers have been included in a 2018 Assisted Living Forum 2017 (2-4 October, 2017) [27]. The EIT Health Innovation-by-Design project (POLLAR: program of the meeting included the workshop “Bridges Impact of Air Pollution in Asthma and Rhinitis). between Europe – integrating health and social care towards innovation” with representatives of RSCN E. Participation of RSCN to International Projects (Maddalena Illario and João Malva). The RS RSCN co-sponsored a WHO-GARD meeting in Brussels Ageing@Coimbra has been leader of the innovative on the impact of air pollution in chronic respiratory activity joining senior citizens and innovators in the diseases (10th November, 2018). It is also co-sponsoring Forum. From local Third Age Universities and nursing an EU Summit held by the Minister of Health of Lithuania homes, 120 +65 people have been invited to visit the on the management of chronic respiratory diseases technological exhibitors in the Forum and to perform the (Vilnius, 23rd March, 2018) and the consensus meeting on evaluation of the technologies. At the end of this exercise, self-management in airways diseases (EIT Health, WHO the most favorite technologies were ranked and a winner GARD), December 2018. was selected. All the exposed technologies received an assessment report, including recommendations provided by the end-users [28]. V. RSCN CHANGE MANAGEMENT MODEL The RSCN follows a change management strategy to accomplish its vision and mission. Although theories may D. Mobile Airways Sentinel network seem abstract and impractical, they can help to solve (MASK@Twinning) common problems [42]. The 3-Step model of the Lewin's The aim of MASK@Twinning is to transfer innovation approach [43] dominated the change management theory from an App developed by the MACVIA-France (MASK, Università degli Studi di Salerno 73 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 and practice for over 50 years. Although criticized, it is [5] Garcia-Lizana F. European innovation partnership on still used [44,45] and has great interest in its simplicity [46]. active and healthy aging: moving from policy to action. The model posits the 3-step sequence of change: Gac Sanit 2013;27:459-62. unfreezing, moving, and refreezing [45,47]. Kotter [48] has [6] Bousquet J, Michel J, Standberg T, Crooks G, added to the collective change knowledge to expand upon Iakovidis I, Gomez M. The European Innovation Lewin’s original Theory (Table 5) [43]. Partnership on Active and Healthy Ageing: the European Geriatric Medicine introduces the EIP on AHA Column. (Table 5. The Kotter’s model of change management Eur Geriatr Med 2014;5:361-2. Adapted from [45]) [7] de-Manuel-Keenoy E, David M, Mora J, et al. Activation of Stratification Strategies and Results of the Many different projects have shown the importance of the interventions on frail patients of Healthcare Services EIP on AHA to achieve its goals. It is, however, urgent (ASSEHS) DG Sanco ProjectNo. 2013 12 04. Eur Geriatr that the concept of AHA is more widely and rapidly Med 2014;5:342-6. translated into practice. The RSCN is one of the key tools [8] Keijser W, de-Manuel-Keenoy E, d’Angelantonio M, of the EIP on AHA to transfer concepts to practice et al. DG Connect funded projects on information and (Step1). communication technologies (ICT) for old age people: The 74 RS of the EIP on AHA represent an exceptional Beyond Silos, CareWell and SmartCare. J Nutr Health group committed to the deployment of AHA in EU regions Aging 2016;20:1024-33. and beyond. The RSCN represents a guiding coalition lead [9] Bousquet J, Addis A, Adcock I, et al. Integrated care by its executive board and strategic members (Step2). pathways for airway diseases (AIRWAYS-ICPs). Eur The RSCN vision and strategy are clearly defined (Step 3). Respir J 2014;44:304-23. The change vision is disseminated through a dedicated [10] Bourret R, Bousquet J, J M, et al. MASK rhinitis, a website and using all means for communication. This single tool for integrated care pathways in allergic rhinitis. paper is an important communication tool. A newsletter World Hosp Health Serv 2015;51:36-9. will be regularly published (Step 4). [11] Bousquet J, Kowalski M, Michel J. The senioral Organizational processes and structures are in place and an policy in Poland uses the expertise of the European ASBL is set and will help to remove the obstacles Innovation Partnership on Active and Healthy Ageing. Eur involved in the process of change. The Regional Events Geriatr Med 2015;6:in press. will help to empower others (Step 5). [12] Liotta G, O'Caoimh R, Gilardi F, et al. Assessment of Short term wins have already been obtained (see chapter frailty in community-dwelling older adults residents in the 4) and a strategy for next year is in place (Step 6). Lazio region (Italy): A model to plan regional community- The goals of step 7 [48] are to achieve continuous based services. Arch Gerontol Geriatr 2017;68:1-7. improvement by analysing the success stories individually [13] van Velsen L, Illario M, Jansen-Kosterink S, et al. A and improving from those individual experiences. Community-Based, Technology-Supported Health Service The goals of step 8 [48] are: for Detecting and Preventing Frailty among Older Adults: 1. Discuss the successful stories related to change initiatives A Participatory Design Development Process. J Aging Res widely. 2015;2015:216084. 2. Ensure that the change becomes an integral part of the [14] Menditto E, Guerriero F, Orlando V, et al. Self- practice and is highly visible. Assessment of Adherence to Medication: A Case Study in 3. Ensure that the support of the existing as well as the new Campania Region Community-Dwelling Population. J leaders continues to extend towards the change. Aging Res 2015;2015:682503. [15] Caoimh RO, Weathers E, O’Donnell R, et al. The Community Assessment of Risk Screening and Treatment Strategies (CARTS) – An Integrated Care Pathway to REFERENCES Manage Frailty and Functional Decline in Community Dwelling Older Adults. In: al HMe, ed. ICT4AgeingWell, [1] Depp CA, Jeste DV. Definitions and predictors of CCIS 578. Switzerland: Springer International Publishing; successful aging: a comprehensive review of larger 2016:1-16. quantitative studies. Am J Geriatr Psychiatry 2006;14:6- [16] Paul C, Teixeira L, Azevedo MJ, et al. Perceived Risk 20. of Mental Health Problems in Primary Care. 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It's just a phase we're going [31] Bousquet J, Caimmi DP, Bedbrook A, et al. Pilot through: a review and synthesis of OD phase study of mobile phone technology in allergic rhinitis in analysis. Group Org Manag 1985;10:383-412. European countries: the MASK-rhinitis study. Allergy [48] Kotter J. Leading change. Boston, USA: Harvard 2017;72:857-65. Business School Press; 1996. [32] Bousquet J, VandenPlas O, Bewick M, et al. Work Productivity and Activity Impairment Allergic Specific Università degli Studi di Salerno 75 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 Reference Country Main Contact Second Contact Site Point point or Coordinator 1 Amsterdam The Netherlands Sabina van der Metropolitan Veen Area 2 Andalusia Spain Ana Carriazo Mercedes Garcia 3 Aragon Spain Juan I. Coll Clavero 4 Arsenàl.IT - Italy Claudio Veneto's Saccavini Research Centre for eHealth Innovation 5 Asturias Spain Nerea Eguren Ana Bernardo Suarèz 6 Aust-Agder Norway Rune Fensli County and Vest-Agder County 7 Baden- Germany Daniel Buhr Württemberg 8 Balearic Spain Elena Cabeza Islands 9 Barcelona Spain Alejandra Millet Province Pi-Figueras 10 Basque Spain Jon Darpón Esteban de Country Sierra Manuel Keenoy 11 Campania Italy Maddalena Illario 12 Catalonia Spain Antoni Dedeu Baraldes 13 Centro Portugal Joao Malva Ana Abrunhosa 14 City of Germany Andreas W. Augsburg Huber 15 City of Spain Jordi Piera Badalona Jiménez 16 City of Finland Sanna Hartman Mr. Heikki Helsinki Kallasvaara Arja Peiponen 17 City of Serbia Milan Vukovic Kraljevo 18 City of Finland Markku Kuopio Tervahauta 19 City of United Kingdom Dave Horsfield Liverpool 20 City of Oulu Finland Anne Rännäli- Salla Hirvonen Kontturi 21 City of Sofia Bulgaria Yanko Stoicho Kuzmanov Katsarov 22 City of Spain Manel Balcells Terrassa Diaz 23 City of Croatia Antonija Zagreb Balenović 24 East of France France Valentin Ledroit 25 Emilia- Italy Maria Luisa Papini Donato Università degli Studi di Salerno 76 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 Romagna Moro Brigida Marta 26 Federal Germany Peter Ministry for Kupferschmid Family Affairs, Senior Citizens, Women and Youth 27 Flanders Belgium Loes Houthuys 28 Friuli Venezia Italy Arrigo Giulia Venchiarutti 29 Galicia Spain Susana Fernandez Nocelo 30 Global Turkey Arzu Alliance Yorgancıoglu Chronic Respiratory Diseases Regional Network 31 Greater United Kingdom Amanda Risino Paul Mc Garry Manchester 32 Healthy The Netherlands Daan Bultje Ageing Network Northern Netherlands 33 Heraklion- Greece Panayiotis Crete Mitsias 34 Île-de-France France Louis Potel 35 Kiev-Zhitomir Ukraine Leonid Bogatyrchuk 36 Kinzigtal Germany Dirk Günther 37 Lazio Italy Ursula Kirchmayer 38 Liguria Italy Lorenzo Bertorello 39 Limburg Belgium Laura Visconti 40 Lodz Poland Lucyna A. Province Wozniak 41 Lombardy Italy Maurizio Bersani 42 MACVIA France Jean Bousquet France Network 43 Madrid Spain Teresa Chavarria Giménez 44 Medical Delta The Netherlands Agaath Sluijter 45 Metropolitan Portugal Elísio Costa Area of Porto (Porto4Agein g) 46 Milan Italy Maria Romano Metropolitan - Università degli Studi di Salerno 77 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 Bergamo Province 47 Region de Spain Beatriz Murcia Martínez- Lozano Aranaga 48 Norrbotten Sweden Lisa Lundgren 49 North Brabant The Netherlands Peter Portheine Province 50 North East United Kingdom Graham England Armitage 51 North West United Kingdom Phil Jennings Eleanor Garnett- Coast of Bentley England Andrew Cooper 52 Northern United Kingdom Elaine Colgan Ireland 53 Nouvelle- France Carole Doucet Aquitaine 54 Oberbergische Germany Wolfgang Judith Brehm r Kreis Goetzke 55 Olomouc Czech Republic Zdenek Gütter 56 Pays De La France Hajjam Jawad Loire 57 Piedmont Italy Valeria Romano 58 Pirkanmaa Finland Anja Tuulonen 70 Twente The Netherlands Miriam Vollenbroek- Hutten 71 Valencian Spain Charo Penadés Javier Gamez Community 72 Wales United Kingdom Nick Batey 73 West Flanders Belgium Inge Taillieu Province 74 Yorkshire and United Kingdom Stephen the Humber Stericker 75 Zealand Denmark Esther Bülow Davidsen Table 1. List and contacts of Reference Sites Co-chairs J Bousquet (MACVIA-France), M Illario (Campania) Vice-Chairs N Batey (Wales), A Carriazo (Andalucia) Treasurer J Malva (Ageing@Coimbra) Scientific adviser N Guldemond (Delta Medica, NL) Members E Colgan (Northern Ireland), J Hajjam (Pays de la Loire), M Perälä-Heape (Oulu, Finland) Adviser J Farrell Table 2. RSCN Executive Baord Membership Description Paying Participation in Voting Ex Board fee* GA, WG, right at member conference GA 1 Full member Full membership is open to all No Yes Yes Yes (up to RS approved by the European 2) Commission 2 Strategic RS that take active and leading In Yes Yes Yes (but member roles in the network species max 10) 3 Honorary  Individuals distinguished in No Yes No No Università degli Studi di Salerno 78 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 member the fields of AHA  They are appointed by the GA upon proposal from the Executive Board 4 Affiliate  Organisations not part of an In Yes No No member existing RS but with an species interest in pursuing similar goals  Only legal entities duly constituted in accordance with the laws of their country of origin, can become an associate member  They are appointed by the GA upon proposal from the Executive Board 5 Observer  Individuals with an interest No Can only No No in AHA who may contribute participate, in an to the work of the RSCN advisory capacity  They are appointed by the in the GA, the GA upon proposal from the WG and the Executive Board conferences upon  Individuals working for invitation by the lobbying groups or for Chair. organisations with a commercial purpose will not be accepted as observers. Table 3. RSCN Membership categories Originator 2016 RS Adopter(s) 2016 RS name Contact person name 1 MACVIA-France 1- Andalucia Jean Bousquet, MACVIA Network (FR) 2- Aragon jean.bousquet@orange.fr 3- Campania 4- Catalonia 5- City of Helsinki 6- Coimbra 7- Heraklion 8- Kohln-Bohn Region 9- Life Tech Valley 10- Liguria 11- Lodz 12- Medical Delta 13- Milan Metropolitan - Bergamo Province 14- NHS 24 15- Northern Ireland 16- Olomouc 17- Pays de la Loire 18- Porto 19- Puglia 20- Regione Piemonte 21- Regione Toscany 22- Region of Southern Denmark 23- Turkey (Global Alliance Chronic 24- ARIA Sweden 25- ARIA Lithuania Università degli Studi di Salerno 79 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 26- ARIA Argentina 27- ARIA Australia 28- ARIA Brazil 29- ARIA Mexico 2 Northern Ireland Catalonia (ES) Michael Scott, Northern Ireland (UK) (UK) email: DrMichael.Scott@northerntrust.hscni.net 3 Northern Ireland Olomouc (CZ) Michael Scott, Northern Ireland (UK) (UK) email: 4 Pays de la Loire Porto Metropolitan Area - Porto4Ageing (PT) Elísio Costa, Porto Metropolitan Area (FR) emcosta@ff.up.pt 5 Northern Ireland North West Coast of England (UK) Michael Scott, Northern Ireland (UK) (UK) email: DrMichael.Scott@northerntrust.hscni.net 6 Campania (IT) Asturias (ES) Ángel Retamar Arias, Asturias (ES) email: 7 Lazio (IT) Porto Metropolitan Area - Porto4Ageing (PT) Elísio Costa, Porto Metropolitan Area emcosta@ff.up.pt 8 Twente (NL) Campania (IT) Lex van Velsen email: 9 Andalusia (ES) City of Zagreb (HR) Ana Carriazo anam.carriazo@juntadeandalucia.es 10 Basque Country (ES) Nouvelle-Aquitaine (FR) Carole Doucet, Nouvelle-Aquitaine email: carole.doucet@nouvelle- aquitaine.fr 11 Medical Delta Campania (IT) Edwig Goossens Rotterdam (NL) email: 12 Republic of Ireland Campania (IT) Rónán O'Caoimh (COLLAGE) Regional Network Catalonia (ES) ronan.ocaoimh@nuigalway.ie (COLLAGE) Metropolitan Area of Porto (Porto4Ageing) 13 Basque Country (ES) Liguria (IT) Dolores Verdoy, Basque Country (ES) dverdoy@kronikgune.org 14 Galicia (ES) City of Zagreb (BG) Susana Fernández Nocelo susana.fernandez.nocelo@sergas.es 15 Scotland (UK) Basque Country (ES) Dolores Verdoy, Basque Country (ES) dverdoy@kronikgune.org 16 Campania (IT) Olomouc (CZ) Zdenek Gütter, Olomouc (CZ) gutter@ntmc.cz 17 Basque Country (ES) Scotland (UK) Donna Henderson, Scotland (UK) donna.henderson1@nhs.net 18 North West Coast of Oberbergischer Kreis (DE) Wolfgang Goetzke, Oberbergischer England (UK) Kreis (DE) info@health-region.de 19 Scotland (UK) Andalusia (ES) Ana Carriazo, Andalousia (ES) anam.carriazo@juntadeandalucia.es 20 Andalusia (ES) City of Kraljevo (SRB) Milan Vukovic, City of Kraljevo (SRB) milan.vukovic@belit.co.rs Table 4. List of Twinnings Università degli Studi di Salerno 80 Translational Medicine @ UniSa-ISSN 2239-9747 2019, 19(11): 66-81 Figure 1: Twinning archetypes Lewin Kotter Step 1: Establish a sense of urgency Unfreezing Step 2: Create a guiding coalition Step 3: Develop a vision and strategy Step 4: Communicate the change vision Step 5: Empower others to act on the vision Moving Step 6: Generate short-term wins Step 7: Consolidate gains and produce more change Step 8: Anchor new approaches in the culture and institutionalize the Refreezing changes Table 5: The Kotter’s model of change management - Adapted from Università degli Studi di Salerno 81