The Role of Health Extension in Practice Transformation and Community Health Improvement: Lessons From 5 Case Studies

The Role of Health Extension in Practice Transformation and Community Health Improvement: Lessons From 5 Case Studies

1. Arthur Kaufman, MD1⇑, 
2. W. Perry Dickinson, MD2, 
3. Lyle J. Fagnan, MD3,
4. F. Daniel Duffy, MD4, 
5. Michael L. Parchman, MD, MPH5 and 
6. Robert L. Rhyne, MD1

+Author Affiliations

1. 1Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
2. 2Department of Family Medicine, University of Colorado, Boulder, Colorado
3. 3Department of Family Medicine, Oregon Health & Sciences University, Portland, Oregon
4. 4Office of Health Care Innovation, University of Oklahoma, Norman, Oklahoma
5. 5Kaiser Permanente Washington Health Research Institute, Seattle, Washington

1. CORRESPONDING AUTHOR: Arthur Kaufman, MD, The University of New Mexico Office for Community Health MSC09 5065 Albuquerque, NM 87131, AKaufman@salud.unm.edu

 

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Abstract

Passage of the Patient Protection and Affordable Care Act triggered 2 successive grant initiatives from the Agency for Healthcare Research and Quality, allowing for the evolution of health extension models among 20 states, not limited to support for in-clinic primary care practice transformation, but also including a broader concept incorporating technical assistance for practices and their communities to address social determinants of health. Five states stand out in stretching the boundaries of health extension: New Mexico, Oklahoma, Oregon, Colorado, and Washington. Their stories reveal lessons learned regarding the successes and challenges, including the importance of building sustained relationships with practices and community coalitions; of documenting success in broad terms as well as achieving diverse outcomes of meaning to different stakeholders; of understanding that health extension is a function that can be carried out by an individual or group depending on resources; and of being prepared for political struggles over “turf” and ownership of extension. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems.

Key words

• health extension
• primary care
• organizational change
• outreach
• population health
• social determinants of health
• practice-based research