ProblemThe Affordable Care Act charged the Agency for Healthcare Research and Quality to create the Primary Care Extension Program, but did not fund this effort. The idea to work through health extension agents to support health care delivery systems was based on the nationally known Cooperative Extension System (CES). Instead of creating new infrastructure in health care, the CES is an ideal vehicle for increasing health-related research and primary care delivery.ApproachThe CES, a long-standing component of the land-grant university system, features a sustained infrastructure for providing education to communities. The Michigan State University (MSU) Model of Health Extension offers another means of developing a National Primary Care Extension Program that is replicable in part because of the presence of the CES throughout the United States. A partnership between the MSU College of Human Medicine and MSU Extension formed in 2014, emphasizing the promotion and support of human health research. The MSU Model of Health Extension includes the following strategies: building partnerships, preparing MSU Extension educators for participation in research, increasing primary care patient referrals and enrollment in health programs, and exploring innovative funding.OutcomesSince the formation of the MSU Model of Health Extension, researchers and extension professionals have made 200+ connections, and grants have afforded savings in salary costs.Next StepsThe MSU College of Human Medicine and MSU Extension partnership can serve as a model to promote health partnerships nationwide between CES services within land-grant universities and academic health centers or community-based medical schools.

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The Cooperative Extension National Framework for Health and Wellness calls for the Cooperative Extension Service (CES) to partner with healthcare professionals to support their patients in preventing illness and promoting health through community education.  Strategies to connect the healthcare system with coordinated referrals to community-based health programs can help patients improve health outcomes.  The Rx for Health Referral Toolkit pilot project was developed as part of a strategy to align CES’s strengths with the medical community to promote quality healthcare experiences for patients.  The toolkit educates healthcare providers about the many health programs offered by CES in Michigan.  It helps ease the burden on healthcare providers by providing a ready-to-use, simple referral tool.  Extension staff were recruited to serve as the point of contact for healthcare provider referrals and conduct outreach with primary care practices utilizing the Rx for Health Referral Toolkit.  As a result of the pilot project, CES educators had 56 new participant referrals directly from healthcare providers.  Prior to this pilot, referrals from healthcare providers were rare. Feedback showed that patients also needed to know what CES is and what it has to offer.  Partnerships between healthcare providers and CES can improve the health of patients nationwide.

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Clinical–community linkages enhance health care delivery and enable physician–patient partnerships to achieve better health. The Michigan State University (MSU) Model of Health Extension includes a strategy for forming these linkages by focusing on increasing primary care patient referrals and enrollment in health programs. This article shares the results of a survey of Michigan internal medicine and family medicine physicians ( n = 323) to better understand attitudes toward and familiarity with community-based education (CBE) programs and to assess the logistical requirements to make CBE referrals efficient and sustainable. Survey results showed that at most, 55% of respondents were aware of at least one CBE program implemented by Cooperative Extension. Of those who were aware, over 85% agreed that the programs have positive benefits for patients. Thirty-five percent reported at least one referral barrier, and familiarity with the CBE programs was a significant predictor for reporting all referral barriers. The results suggest that increasing physicians’ familiarity of CBE health programs is a key first step in identifying ideal strategies to overcome referral barriers. Data from this study may help determine scalable state level models for increasing awareness of chronic disease prevention and other CBE programs in efforts to improve the health of the nation.

A statewide education program provided prospective homebuyers with information to support long‐term preservation of affordable homeownership. Between 2012 and 2015, a sample of 1,561 Michigan residents completed pre‐ and post program evaluation surveys. The surveys measured 12 outcomes of the homeownership education program. Change scores were calculated for participants, and paired t‐tests were used to compare pre‐ and postsurvey means for each of the 12 outcome measures. The results of both change scores and t‐tests showed that homeownership education increased the participants’ knowledge of financial requirements for buying a home and practices to prevent predatory lending and foreclosure. The financial practices in which the largest percentage of participants reported an intention to change were as follows: tracking spending, creating a budget, calculating a reasonable housing payment, identifying patterns to adjust, and developing a plan to change financial habits.

An evaluation was implemented over a 3-year period to assess a statewide financial capability program for low-income, diverse clientele in Michigan. Pre- and post- program evaluation data was used to determine knowledge gain and intended behavior change. Follow-up evaluation data confirmed behavior changes across 10 financial practices. Using the Transtheoretical Model of Behavior Change, research findings revealed participants were better able to maintain change in key financial practices including making wise money decisions, creating a spending plan, and managing debt as a result of the educational program. Recommendations are provided to support future programs with similar clientele.

Recognizing the need for education that addresses social emotional and mental health issues faced by adults, Extension developed two different types of programs. Michigan State University (MSU) Extension developed the RELAX: Alternatives to Anger program (RELAX) to address anger management, and West Virginia University (WVU) Extension created Stress Less with Mindfulness (SLM) to build stress management skills among adults. At a national conference, the two states independently shared their programs’ objectives and delivery implementation and then later cross-trained each other’s Extension team. The research reported here shares the designs of both stress-reduction health programs and the results of a combined two-state SLM evaluation with 1,304 participants. The benefits of SLM included skill learning and practice. Recommendations for practice include state Extension services sharing curricula resources, training teams from each other’s states, and jointly implementing evaluation protocols. Extension professionals looking for established programs that help people gain skills to promote emotional health and stress-reduction may consider implementing one of these community-based programs in their states.