RT Journal Article SR Electronic T1 The Role of Health Extension in Practice Transformation and Community Health Improvement: Lessons From 5 Case Studies JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP S67 OP S72 DO 10.1370/afm.2409 VO 17 IS Suppl 1 A1 Arthur Kaufman A1 W. Perry Dickinson A1 Lyle J. Fagnan A1 F. Daniel Duffy A1 Michael L. Parchman A1 Robert L. Rhyne YR 2019 UL http://www.annfammed.org/content/17/Suppl_1/S67.abstract AB 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.