The landscape of healthcare is continuously evolving, with a growing emphasis on enhancing primary care to improve patient outcomes and community health. Recognizing this critical need, the Agency for Healthcare Research and Quality (AHRQ) launched the “Infrastructure for Maintaining Primary Care Transformation (IMPaCT)” initiative. This groundbreaking program, spanning from September 2011 to September 2013, funded four cooperative agreements aimed at bolstering state-level primary care quality improvement (QI) and practice transformation. At the heart of these initiatives was the implementation of Primary Care Extension Program models, designed to disseminate best practices and support healthcare providers in delivering superior care. New Mexico, North Carolina, Oklahoma, and Pennsylvania were the pioneering states selected to receive AHRQ IMPaCT grants, each demonstrating prior success in establishing robust QI infrastructures within primary care.
This article delves into the core efforts and activities undertaken through the IMPaCT grants, synthesizing crucial lessons gleaned from these initiatives. We will explore effective strategies for building primary care QI capacity and discuss future avenues for research, program sustainability, and broader expansion of primary care extension programs.
Understanding Primary Care Extension Programs
The concept of a primary care extension program (PCEP) is rooted in Section 5405 of the Patient Protection and Affordable Care Act. PCEPs are mandated to empower primary care providers through education and support, focusing on vital areas such as preventive medicine, health promotion, chronic disease management, and mental and behavioral health services. These programs emphasize evidence-based and evidence-informed therapies and techniques, equipping providers to seamlessly integrate these advancements into their daily practice and, crucially, to enhance community health in collaboration with community-based health connectors.[1]
A cornerstone of any effective extension program is the deployment of extension agents. Often referred to as practice facilitators or health extension agents, these professionals act as catalysts for change within primary care settings. Practice facilitators work collaboratively with diverse entities including health departments, universities, and community health agencies. Their mission is to provide tailored technical assistance and facilitate QI initiatives and system redesign within practices.[2] Furthermore, extension agents play a vital role in community engagement. They collaborate with local health departments, community health centers, tribal organizations, and other community agencies to pinpoint pressing community health priorities and local health workforce needs. This collaborative approach extends to participating in community-driven efforts aimed at addressing the social determinants of health, strengthening the primary care workforce at the local level, and actively working to eliminate health disparities.[1]
Primary care extension programs frequently underpin patient-centered medical home (PCMH) redesign endeavors. PCMH models are characterized by a commitment to quality improvement strategies, the implementation of population management techniques for defined patient panels, and the organization of care around a cohesive primary care team. They prioritize engaging patients and their families in health management and ensuring seamless care coordination across various healthcare settings. As defined by AHRQ,[3] the PCMH model is built upon five core functions and attributes:
- Comprehensive Care: Addressing the full spectrum of patient needs.
- Patient-Centered Care: Tailoring care to individual patient preferences and values.
- Coordinated Care: Integrating services across different healthcare providers and settings.
- Accessible Services: Ensuring timely and convenient access to care.
- Quality and Safety: Continuously improving the safety and effectiveness of care delivery.
Numerous national and state-level PCMH recognition and accreditation programs exist to promote and validate these models. Importantly, many practices leverage practice facilitation to drive their QI activities, regardless of whether they formally pursue PCMH recognition.
The AHRQ IMPaCT Initiative: Fostering National Primary Care Transformation
AHRQ conceived the IMPaCT initiative as a strategic investment in state-level primary care QI and transformation. The initiative’s overarching goal was to identify and evaluate successful programs that could serve as blueprints for other states seeking to enhance their primary care systems.[4] The IMPaCT initiative was structured around three core objectives:
- Demonstrating diverse approaches to building effective PCEPs.
- Scaling up existing programs to deliver immediate benefits to primary care practices and communities.
- Creating a platform for shared learning and knowledge exchange across states.
Each of the four IMPaCT grantees, designated as “model States,” partnered with three or four “partner States,” also known as “spread States.” This collaborative framework facilitated the dissemination of successful infrastructure models developed by the model states. In total, 17 states actively participated in the initiative, collectively working to develop, expand, and refine state-level programs designed to assist primary care practices in their QI and redesign efforts. Figure 1 visually represents the network of states involved in this transformative initiative.
The IMPaCT grants were structured as cooperative agreements, ensuring active engagement of AHRQ program officials throughout the project lifecycle. AHRQ fostered cross-project learning through regular teleconferences and further facilitated in-person collaboration by awarding a conference grant that brought together all model and partner states in 2013. This emphasis on shared learning and collaboration was instrumental in accelerating the adoption of best practices and maximizing the impact of the IMPaCT initiative.
For those seeking deeper insights into the impactful work of the IMPaCT grants, the AHRQ project website serves as a comprehensive resource. It features a rich catalog of tools and resources developed by the IMPaCT grantees and partner states, designed to support and train others in primary care transformation and QI methodologies. The website also offers concise profiles summarizing key aspects of each project and compelling success stories that highlight the unique achievements of each grant within their partner states. These resources provide valuable guidance and inspiration for stakeholders committed to advancing primary care excellence through primary care extension programs.
