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Photo: Auburn University Libraries |
As momentum builds for health reform legislation in the 111th Congress, calls to rebuild the crumbling primary care infrastructure in the United States are reaching receptive ears, with public and private advisory groups including the Medicare Payment Advisory Commission and the National Business Group on Health recommending increased payments for primary care. New investment in primary care is necessary, but not sufficient to create modernized, high performing primary care medical homes unless joined to a strategy for disseminating and implementing innovations and best practices. As the family medicine TransforMED program and other efforts in practice improvement have found, to successfully redesign practices requires knowledge transfer, performance feedback, facilitation, and HIT support provided by individuals with whom practices have established trusting relationships over time. The farming community learned these principles a century ago. Primary care practices are very much like the small farms of that era which were geographically dispersed, poorly resourced for change, and inefficient in adopting new techniques or technology, but vital to the nation’s well being. Practicing physicians need something akin to the agricultural extension agent which was so transformative for farming.
Health reform legislation should include establishment of a nationwide Primary Care Cooperative Extension Service, modeled after the US Department of Agriculture’s Cooperative State Research, Education, and Extension Service which so successfully accelerated farm transformation. Similar to the USDA program, a new Primary Care Extension Program would establish partnerships between community-based primary care clinicians and university-based centers of excellence to facilitate practice redesign, adoption of team-based care models, shared care management resources, workforce development, and other activities. County-based health extension organizations would support primary care clinicians in the same manner that the agricultural model assists family farmers, providing infrastructure for local learning communities and practice transformation. Successful progenitors of primary care extension programs exist in several states and demonstrate the promise of taking a Primary Care Extension Program to scale nationwide.
For more information:
- Ensuring Access to a Modern, Medical Home: The Role for a Primary Care Extension Program in Health Reform
- Primary Care Extension Agent Concept Diagram [1-page PDF; About PDFs]
- The Oklahoma Physicians Resource/Research Network (OKPRN)
- The Center for Excellence in Primary Care, the University of California, San Francisco
- Community Care of North Carolina
- The New Mexico Health Extension Regional Offices (HEROs)
- TransforMED
- Improving Primary Care: Strategies and Tools for a Better Practice
- Bibliography [1-page PDF; About PDFs]
