Milan Pilot:
 Casa di Cura Privata del Policlinico (CCI)

Casa di Cura del Policlinico (CCPP) in Milan, CCPP is a fully integrated multispecialty clinical centre aiming at providing both inpatient and outpatient services mainly directed to neurological patients. The Centre is constituted as a Department of Neurorehabilitation Sciences, accredited by the Italian National Health System, and economically supported by Regione Lombardia.
It includes the Rehabilitation Specialized Operative Unit, which consists in 148 beds accredited by the National Health System. Research is mainly dedicated to the Neurological Sciences, the Neurorehabilitation Sciences and to Quality of Life. CCPP collaborates in national and international partnerships in innovative research fields, both clinical and technological, applied to neurorehabilitation and frailty conditions in aging. The active collaboration in European projects during the last years led CCPP to achieve national and community funding, on notice by European Commission (H2020, MSCA and AAL), Italian Health and Research Ministry and Lombardia Region.

The centre is actively collaborating with the EIP on AHA, a pilot initiative launched by the EC to foster innovation in the field of active and healthy ageing.

CCPP became member of the Action Group A2 “Personalized health management and prevention of falls”.

The clinic enrolls about 1000 patients/year. CCPP can provide the following:

• clinical and disease area experts with specific knowledge of the Parkinson disease;
• clinicians and psychologists with expertise in the critical aspects of ADL and HRQOL, including psychological aspects of the assessment of the personal perceived disabilities as well as of caregivers and attending staff or physicians to corroborate the patient profile;
• clinical and statistical experts with demonstrated knowledge of the design and conduct of clinical studies, specifically for technology-enabled treatments/evaluations and in the drug delivery for neurodegenerative diseases, financed by Roche and Biogen;
• expertise in the clinical evaluation of devices and sensors of remote assessment technologies (wearable, off-body) that could be further developed or modified for use in the consortium;
• expertise in clinical data management (redcap as eCRF) and movement assessment algorithms (fall prevention);
• expertise in patient advocacy and engagement, through a specific partnership with the Catholic University of Milano;
  presence of an existing longitudinal cohort of 400 patients, evaluated with clinical and digital scales at the beginning and at the end of the rehabilitation programme. CCPP provides an ideal setting for promoting translational research in
• Neurodegenerative Diseases in order to facilitate the rapid transfer of research knowledge to the clinical environment.

The organization is improving ICT enabled projects with academic, research and industrial partners in order to extend the range of services aimed to an effective continuity of care. In this sense, research activities are pursuing in the direction of personalized rehabilitation programs. Big data, cognitive technologies, body and environmental sensors, cameras, mobile apps (e.g.
serious gaming), brain computer interface and robotics will support this process in monitoring behavioral profiles and physical activities in aging.

Aging society

• The percentage of people aged 65 or more among total population (2016) was 18.7%.
• Life expectancy in Italy is among the highest in the EU (83.35 years, EU average is 80.9).
• By 2050, the older person ratio will exceed 70% in Italy.
• Highest number of elderly people living in Northern urban regions.
• There are 7,058,755 people aged 75 and over who reside in Italy, 11.7% of the total population (60% women). Almost half of women aged 75 and over live alone, 29% as a couple, while 21.7% of men live alone and 68% with a partner.
• The percentage of older people who use internet at least daily in 2019 was 29%.

Parkinsons

• The incidence and prevalence rates of Parkinson's disease in Italy are similar to those in the rest of Europe¹. According to current population estimations, there are at least 400.000 people with Parkinson's disease with a prevalence rate of 193.7/100,000²
• In addition, the disease generates sizeable costs. In fact, antiparkinsonian drugs are where the primary component of costs paid by the health insurance (39.6%) and one of the most expensive components of the direct costs (24.0%). The highest copayments made by people are for antiparkinsonian drugs and medical equipment (58%). Antiparkinsonian pharmacotherapy is one of the major cost components of PD-related costs for health insurance. It imposes a considerable economic burden on patients and their families as well.³

Caregivers

• Caring for a person with Parkinson's disease (PD) is associated with an increased risk of psychiatric morbidity and persistent distress.⁴ Studies underlie how major attention must be given to the early identification of factors generating stress in caregivers in order to improve caregiver quality of life and patient's care.⁵
• It is mostly women (wives and daughters) who take care of people with Parkinson's disease (76.4% vs 23.6% of men). The average age of the caregiver is 59 years (58 for women and 62 for men). They reside mainly in the North (39.4%) and in the South (36%), less in the Center of Italy (24.6%). The wives are mainly caring for sick men (in 65.3% of cases), while for females the share of male caregivers increases (42.4%), who are still less than women (57.6%) usually the daughters.

Health and care professionals

• In the Beveridge models, the family physician plays a central role in the diagnosis and treatment of people, along with the specialists.
  Once the person is referred to the specialist, neurologists plan monthly outpatient visitation (about 2-3/year) and eventually can schedule inpatient stays for defining the diagnosis, for improving the treatment and for personalized neurorehabilitation treatments.
• ther professional figures (physiotherapists, speech therapists, occupational therapists, neuropsychologists) play a central role as well in the care of the person.
• Since COVID 19 pandemic, outpatient visits and neurorehabilitation treatment in hospital may be limited, and remote resources as telemedicine are encouraged.

1 https://ec.europa.eu/research/index.cfm?pg=events&eventcode=70814C79-B44D-8FC7-CBC94FD9083A9F41

2 Riccò M, Vezzosi L, Balzarini F, Gualerzi G, Ranzieri S, Signorelli C, Colucci ME, Bragazzi NL. Prevalence of Parkinson Disease in Italy: a systematic review and meta-analysis. Acta Biomed. 2020 Sep 7;91(3):e2020088. doi: 10.23750/abm.v91i3.9443

3 Winter Y, von Campenhausen S, Reese JP, Balzer-Geldsetzer M, Longo K, Spiga G, Boetzel K, Eggert K, Oertel WH, Dodel R, Barone P Costs of Parkinson's disease and antiparkinsonian pharmacotherapy: an Italian cohort study. Neurodegener Dis. 2010;7(6):365-72. doi: 10.1159/000302644.

4 Caregiver burden and its related factors in advanced Parkinson's disease: data from the PREDICT study.
Tessitore A, Marano P, Modugno N, Pontieri FE, Tambasco N, Canesi M, Latorre A, Lopiano L, Sensi M, Quatrale R, Solla P, Defazio G, Melzi G, Costanzo AM, Gualberti G, di Luzio Paparatti U, Antonini A.J Neurol. 2018 May;265(5):1124-1137. doi: 10.1007/s00415-018-8816-9. Epub 2018 Mar 7.PMID: 29516169

5 Predictors of caregiver burden in partners of patients with Parkinson's disease. D'Amelio M, Terruso V, Palmeri B, Di Benedetto N, Famoso G, Cottone P, Aridon P, Ragonese P, Savettieri G.Neurol Sci. 2009 Apr;30(2):171-4. doi: 10.1007/s10072-009-0024-z. Epub 2009 Feb 3.PMID: 19189044