Since imitation is the most sincere form of flattery, the nation's Cooperative Extension service got a tremendous compliment in an article that outlined a plan by UC San Francisco physician Kevin Grumbach.

He told a Washington gathering of family physicians that the federal government should establish a cooperative extension service modeled after the one created nearly 100 years ago by the USDA. The new system, administered by HHS, would help primary care physicians transform their practices into patient-centered medical homes, according to a story posted yesterday on the American Academy of Family Physicians Web site about Grumbach's April 23 presentation.

Grumbach's idea has "the real action" taking place at the local level, with county extension office personnel working directly with medical practices.

"(Local agents) would create a sense of local learning communities among all primary care practitioners in a county, or a group of counties, or in sparsely populated rural counties," Grumbach is quoted.

In his presentation, Grumbach noted that CE agents (in California, "advisors") are placed in every county to serve as "coaches" helping farmers adopt new technologies and new methods of farming. The agent also helps facilitate the sharing of best practices and the exchange of information.

"At this point, we know what a high-performing, advanced primary care medical home looks like," Grumbach is quoted. "The problem is, change is hard, particularly in primary care. While you are on that hamster wheel running as fast as you can, it is very hard to step off and engage in the process of practice change."

Grumbach's idea speaks to the genius of the cooperative extension model as it is currently offered to the agricultural industry, and the importance of ensuring it is not dismantled.