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

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.

Formación de recursos humanos para la salud universal: acciones estratégicas desde las instituciones académicas

“…Afortunadamente, existen experiencias que se apartan de los modelos tradicionales de formación y son contrahegemónicas (19,20), que se basan en modelos curriculares que propician el tránsito horizontal entre las carreras de la salud y de las ciencias sociales y que contienen ciclos comunes, así como de práctica comunitaria, rompiendo así con modelos de currículos tubulares inconexos que poco aportan a la mirada interdisciplinar y al trabajo en equipo.…”

Individual-Level and Neighborhood-Level Factors Associated with Longitudinal Changes in Cardiometabolic Measures in Participants of a Care Coordination Program

“…[7][8][9][10][11][12] However, most primary care practices do not have time or resources to offer widespread care coordination, individual-level social and behavior risk screenings, and community-based support. [13][14][15][16][17][18] Tailoring community-based approaches to high-burden communities, people living in poverty, or those with low literacy is recommended for reducing CVD disparities. [11] Support outside clinic walls needs to be tailored to individuals who do not bene t from clinic-based interventions.…”

Task Sharing Chronic Disease Self-Management Training With Lay Health Coaches to Reduce Health Disparities

“…3,17,18 The sustainability of lay health coach interventions in community settings beyond grant funding, however, is challenged by the lack of widespread reimbursements for these programs. 19 Community coalitions targeting population health outcomes have been successful in promoting health equity by implementing policy and structural changes in deprived neighborhoods. 20 There is a need for research that supports policy and payment models that integrate lay health coach programs to mitigate individual and familial social risks that impact chronic disease outcomes into primary care settings in socially deprived areas.…”