NORSE: Building bridges between psyche and soma through personalized and dynamic mental health systems

The project titled "Norse Feedback - Establishing Synergies between Psyche and Soma through Personalized Dynamic Mental Health Systems" has been successfully implemented during the period 2017-2023. The primary organizatrion responsible for overseeing the project has been Helse Førde, with significant collaborative partners including industrial collaborator Norse Feedback AS, clinical trial sites Førde Medical Center and St. Olavs Hospital, as well as research providers Western Norway University of Applied Science and Weill Cornell Medical School. The outcomes stemming from the project are diverse and span various sectors. As an innovation initiative under the HELSEVEL framework, the project's objectives encompassed contributing to research outcomes, influencing clinical protocols, and fostering opportunities for commercialization and industrial growth. In this report, we emphasize the overarching achievements within these distinct sectors. In the clinical sphere, the project has notably facilitated the expanded utilization of the clinical feedback system, Norse Feedback, to enhance patient involvement and concentration within treatment processes across various contexts. Notably, within the specialized healthcare sector, Helse Vest has mandated the implementation of this technology's application and content across all mental health divisions within the region, addressing a population of one million people. This implementation is substantial and has been ongoing since 2022. Consequently, this will introduce a novel offering of data-driven patient participation to all individuals within the Helse Vest region by the culmination of 2023. Collaborative partner Norse Feedback has also augmented its market reach, providing technology to 50 Norwegian municipal healthcare services and the majority of student healthcare services throughout Norway. The clinical service provisions for patients within these facilities will be enhanced as a direct consequence of these advancements. These instances exemplify how the project has been instrumental in effecting transformative change and innovation at the clinical practice level. From a commercial standpoint, collaborative partner Norse Feedback has demonstrated emerging financial robustness and has also successfully established a presence in the United Kingdom and Ireland, engaging in piloting and commercial deployment of their technology. A significant outcome of the project lies in the creation of regional expert work places, thereby contributing to regional economic development. The aspirations and potential for Norse Feedback's continued growth post the project's conclusion are substantial, with the company also actively engaged in other innovation initiatives. In terms of research impact, the project's outcomes align with the two primary dimensions by which research is commonly evaluated. Scientific publications detailing the processes and outcomes have been disseminated throughout the project duration. Due to the typical timeframes associated with the publication process, there are still articles currently in progress, planned to be published subsequent to the conclusion of the funding period. This particularly applies to articles pertaining to results derived from the obesity context, where data collection was finalized in 2022. Additionally, the outcomes have been presented annually at international conferences. The second form of outcomes facilitated by the project encompasses continued research initiatives securing funding. Since the inception of this project, several PhD projects, post-doctoral projects, and a larger strategic funding allocation supported by Helse Vest have emerged, sustaining the research approach within the realms of pain management, stoma treatment, and health economics. Cumulatively, research funding across various Norse Feedback applications has now exceeded 50 million NOK. Further continuation has also secured preliminary funding within the framework of NFR's PilotHelse initiative, with a primary application expected to be submitted for this funding call in 2023. Lastly, a final domain of outcomes the project has yielded pertains to innovation in education and health pedagogy. The outcome labeled "Active Clinical Reflection" constitutes a digital resource, directly rooted in the research conducted within Work Package Two. This innovation has received supplementary funding for its development and has been fully realized and implemented. Leveraging structured videos derived from research knowledge, this innovation engages groups of professionals in reflection processes aimed at enhancing outpatient clinical practice. This innovation is integrated into specialist healthcare seminars, student training, and professional conferences, and is made readily accessible to interested stakeholders without charge.

-

The Norwegian Outcome Response System for Evaluation (NORSE) is a second generation Routine Outcome Monitoring (ROM) innovation, with a dynamic clinical feedback system (CFS), developed at Førde Hospital Trust. NORSE has advanced significantly on existing methodologies in that the system A) actively learns from, and B) adapts to, the individual patient´s feedback, and C) instantaneously personalizes the system to individual profiles of suffering and resources. The present proposal details research needed for the next level of development, and for moving NORSE into regional and national use both in mental health clinics and in somatic health care. The group of researchers proposing this project has longstanding experience with research on clinical feedback on mental health, on patient and clinician driven research, and on obesity research. We propose a research program based on advanced quantitative and qualitative research methods to achieve our objectives. Research challenges addressed by this project can be summarized into four domains: A) We need to develop ROM/CFS with psychometrically valid dimensional clinical profiles. Large datasets and advanced statistics must be employed. B) Psychometric properties are only half the story in the effect of ROM/CFS: implementation knowledge is key to outcome and need to be part of research protocols in naturalistic settings. C) Structured work with mental health knowledge in obesity settings is non-existent: Research into these domains is breaking new ground and should thus be experimental. D) Structured access to specialized mental health knowledge to support evaluation and referral in primary care is rare. Research into these domains should thus be experimental. On this background, the project group proposes three work packages: 1) NORSE in the mental health clinic, 2) NORSE in the obesity clinic: improving mental health after bariatric surgery, and 3) NORSE improving services and the general practitioners office.