The Affordable Care Act authorized, but did not fund, the Primary Care Extension Program (PCEP). Much like the Cooperative Extension Program of the US Department of Agriculture sped the modernization of farming a century ago, the PCEP could speed the transformation of primary care. It could also help achieve other goals such as integrating primary care with public health and translating research into practice. The urgency of these goals and their importance to achieving the Triple Aim for health care should increase interest in rapidly building the PCEP, much as the need to feed the country did a century ago. 2013;11:173-178. doi:10.1370/afm.1495. Ann Fam Med INTRODUCTIONP assage of the Affordable Care Act of 2010 (ACA) laid a foundation for unprecedented support of primary care, placing it at the core of a learning health care system that seeks to achieve the Center for Medicare and Medicaid Services' Triple Aim: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.1 This article seeks to help clinical and policy leaders understand how critical the Primary Care Extension Program (PCEP) is to enhancing primary care effectiveness, to the integration of primary care and public health, and to translating research into practice, all with the goal of achieving the Triple Aim for health care. 2,3 Before the ACA, primary care leaders were already engaged in designing and testing new models of care, particularly the patient-centered medical home (PCMH). Evidence suggesting that these reformed models of primary care improve health outcomes while reducing costs has stimulated a surge of interest for widespread transformation of primary care. 4,5 Many of these high-performing models have increased capacity for monitoring and managing population health, and some have bridged the substantial gap between primary care and public health. 6,7 Despite early evidence and growing enthusiasm, primary care transformation has not yet arrived at a tipping point, and the United States lacks a mechanism for facilitating the change. PRIMARY CARE EXTENSION PROGRAMAnticipating these challenges to primary care transformation, the ACA authorized the Agency for Healthcare Research and Quality (AHRQ) to create a national the PCEP. This section of the law states that the principal charge of the PCEP is to "assist primary care providers to implement a patient-centered medical home to improve the accessibility, quality, and effi ciency of primary care services" through local deployment of community-based Health Extension Agents. In addition to their practice facilitation roles, these agents may "collaborate with local health departments, community health centers, tribes and tribal entities, and other community agencies to identify community health priorities and local health 7 This Institute of Medicine study specifi cally mentions the PCEP as an important model for developing these partnerships. Roots in the Department of Agriculture's Cooperative ExtensionThe PCEP builds upon...

This study examined the roles and effectiveness of nurse partner-provided diabetes self-management (DSM) support in five rural primary care clinics. There were two to nine providers and one nurse partner in each clinic; nurses were licensed practical nurses (LPNs) in all but one clinic. Interviews with providers and observations of patient interactions assessed nurse roles, clinic processes, and communication patterns. Using immersion-crystallization methods, three major themes explained nurse partner role variation: "gatekeeper" role of providers, compression of time and space within clinic work flow, and nurses' educational background and experience. While nurses' education and experience were important, clinics where providers facilitated nurse participation in DSM support through focused communication and commitment of time and space most effectively integrated DSM support into their practice. Some quantitative measures improved; notably glycated hemoglobin level and patients' frequency of blood glucose measurement. Study findings provide guidance on using nurses in primary care clinics to provide DSM.

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perceived stress and improving lifestyle behaviors compared to the effectiveness of a strength training program. The pilot program included research-based strategies from the field of positive psychology with a strong focus on mindfulness.Participants both programs completed surveys at baseline (time 0) (n = 477), immediately following the programs (time 1) (n = 390) and three months following the programs (time 2) (n = 299). Surveys at each timepoint assessed participants' perceived stress levels, tobacco use and health promoting lifestyle behaviors.Too few tobacco users were identified for this outcome measure to be included in the analyses. Participants of both program groups showed significant improvements in stress levels and health promoting lifestyle behaviors from time 0 to time 1. However, improvements in health promoting lifestyle behaviors, with the exception of physical activity and social health behaviors, from time 0 to time 1 were significantly greater for the participants of the pilot program. In comparison to the strength training program, the pilot program showed significantly greater improvements across all three timepoints and from time 0 to time 2 for all outcome measures with the exception of physical activity and social health behaviors. Participants of both programs significantly maintained improvements made as a result their program participation.This study adds to the limited amount research evaluating the effectiveness of stress management programs in improving health behaviors.