Chris Friese (N'97) never intended to get involved in research. He never even had any interest in it.

Funny how things turn out.

"I've learned that research is an exciting thing," Friese said. "I really got the research bug being here, being with these investigators, learning the things that they've been doing, and learning how their research has huge implications for practice."

"Here" is the Center for Health Services and Policy Research , a Penn organization that designs and implements evaluations for clinical practices within the nursing school. Friese, now a junior, joined the center his freshman year. Not because he wanted to try his hand at research. Because he wanted to work closely with the center's director, nursing and sociology professor Linda Aiken.

Friese became familiar with Aiken's work during his first semester. Like all first-year nursing students, he was required to take an introductory course in nursing. The syllabus for this mandatory class included "Charting Nursing's Future: Agenda for the 1990s," a book that Aiken co-edited.

Impressed by Aiken's prominence in the nursing field, Friese was determined to work with her. He didn't have to wait long for his chance. While riding an elevator in the Nursing Education Building , Friese noticed an ad for the Center for Health Services and Policy Research. Aiken needed work-study students.

It was a golden opportunity that Friese had no intention of missing. Unfortunately, when he applied at the center, he received some bad news. Other nursing students had also seen the ad--earlier. All of the work-study positions were filled.

Friese was undaunted. If the center couldn't hire him as a paid employee, then he would work for free. He volunteered his services, gratis. Aiken accepted.

At first, Friese spent his time at the center photocopying and filing--duties he performed diligently. However, Aiken quickly recognized the freshman's potential. Realizing that Friese possessed strong intellectual and organizational skills, Aiken appointed him to the position of research assistant.

As Friese sharpened his investigative skills, Aiken told Lois Evans, associate professor and director of academic nursing practices, about her researching prodigy. At the time, Evans was establishing the Collaborative Assessment and Rehabilitation of Elders (CARE) Program, a multidisciplinary project between the School of Nursing, the School of Medicine and some departments at HUP.

"Our program is aimed at a group of old people who tend to fall through the cracks," Evans explained. "They're not sick enough to get into a nursing home immediately, but they start falling, or they have the flu, and they get depressed and stop eating, and then they get weaker.

"Once they get started, unless something arrests that process, they are on the course for multiple hospital stays, and eventually a nursing home and death. If you intervene early enough and strongly enough, you can produce some sort of plateau and actually improve functions."

Evans had confidence in CARE, believing that the program could benefit a neglected portion of the elderly population. What she didn't have was proof.

Aiken and Evans assembled a research team to evaluate the fledgling CARE Program. As a bright research assistant, Friese was one of their first choices. "He showed great promise as a researcher and as a clinician, so we thought he would be an excellent person to take a leadership role in this particular project," Aiken said.

They also believed that an undergraduate could make a valuable contribution to the project. And vice versa. "Our graduate program is only one year long in the nursing school," Evans explained. "So the master's student may get involved in something, but it's not very long-lived. And this was clearly something that would be a greater experience for someone if they had a longer period time to be involved in it."

Friese said that evaluating CARE has been a unique experience. That's because CARE, itself, is a unique program. Its clinicians specialize in nursing, medicine, rehabilitation, mental health and social services. Under the supervision of a nurse practitioner, they develop individual treatment plans for each patient.

"A lot of these patients may be trying to recover from a stroke or a hip fracture, or may just have been evaluated by a physician who seems to think that they are being deconditioned or increasing in frailty," Friese said. "So they are referred to the program for a tune-up, to keep them at an optimal level of function."

Since CARE is so unique, the research team had difficulty finding a group comparable to the program. "Even though we are listed as a CORF [Comprehensive Outpatient Rehabilitation Facility] under Medicare," Evans said, "I haven't found any other CORFs in the country that are only serving the very frail elderly, and none of them are managed by, and use the services of, advanced practice nurses in the way we do."

With no matching group readily available, the researchers turned to Medicare data sets. Friese and the rest of the research team are now compiling a list of patients who share certain criteria with CARE patients--such as age, type of medical problems, number of hospital visits, and so on.

"We want to look at this sample group from the Medicare data segment, compare them to our group in terms of functions and outcomes, and see if our patients are doing better than this supposed control group," Friese offered. "We are trying to identify this other population right now and determine if these kinds of data sets are useful in policy analyses."

Over the last two years, 278 patients have undergone therapy at the CARE facility at Ralston House. Friese has helped keep track of them all. Through a telephone call and a few questions, he can determine how well the program worked for each patient. So far, the patients have demonstrated definite progress.

"We have some follow-up data to show that they are, in fact, improving in their functional ability, meaning physical function and activities of daily living," Evans said. "We also know that many of them are improving in their mood, because many of them are quite depressed when they first come in here."

Thus far, Friese has put together two small pilot studies. The data he's now collecting will be part of preliminary research that should be concluded next year. Ultimately, he and the other researchers hope to prove that the CARE Program is a cost-effective solution to nursing homes and hospitalization. If they succeed, the results could revolutionize the health-care system.

"We are trying to demonstrate that interdisciplinary programs, specifically with a nursing focus, can do a great deal for these patients," Friese said. "And that has policy implications when we are trying to decide where we go with our medical care. What's better--to have [elderly patients] in an outpatient setting where they can go home and live with their families or loved ones, or institutionalization or recurrent hospitalization? What's a better quality of life for these people? These types of questions need empirical documentation for the research community, the health managers, the people designing new ways of servicing, the policy-makers."

Evans noted that Friese is only one of the many undergraduates who perform research at the nursing school. And Friese noted that he is only one of the many undergraduates who perform research at Penn. He said that many of his friends are involved in research. And he believes that the 21st Century Undergraduate Project will allow even more undergraduates to take advantage of research opportunities. He would encourage them to do so.

"For me, the research component here has been the most-amazing part of being at Penn," Friese said. "Research has been a great way for me to enhance what I'm learning in the classroom and in the hospital. I plan to remain active in it, and probably plan a career in it."

Aiken is happy to hear that. She will be even happier if Friese plans his career at Penn.

"I keep telling Chris he needs to stay here and go to graduate school," she said with a smile.

Return to Compass Features for April 30, 1996