Moving upstream-health extension and primary care

Health extension programs represent an opportunity for practice-based research networks (PBRNs) and primary care practices to develop collaborations reaching beyond the clinic walls to address the upstream social determinants of health and engage in community-based research. The Health Extension Regional Officers (HEROs) program at the University of New Mexico described in this issue of the JABFM is an innovative model with a bidirectional approach to linking academic health centers to communitybased practices and organizations. Health extension programs are local, influenced by history, relationships, and support. Oregon's health extension workforce represents a diverse group that includes practice facilitators, community health workers, and Cooperative Extension agents. PBRNs are measuring success in terms of collaboration across a spectrum of health activities. The Oregon Rural Practicebased Research Network uses a "Four Pillars" model of community engagement, practice transformation, research, and education to involve researchers, health policy experts, educators, and health extension workers to improve community health.