Mapping AHRQ's 30-Year Investment in Primary Care Research (1990-2020)

The National Academy of Medicine (NAM, formerly known as the Institute of Medicine or IOM) defines primary care as "the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community."¹ NAM published an updated definition of primary care in 2021 that reaffirms its 1996 definition and incorporates concepts of whole-person and equitable care delivered by interprofessional teams to improve health and wellness.² Primary care is a function, not simply a discipline, specialty, or service line in which comprehensive, continuous, coordinated, first-contact care is provided to patients of all ages, backgrounds, and socioeconomic circumstances.^1,3 A well-functioning primary care system is foundational to achieving the important aims of healthcare: improved health outcomes, reduced costs, enhanced patient and clinician experience, and health equity. Yet, primary care in the United States faces many challenges, including increased clinician demands and expectations, patients with increasing medical complexity, a clinician shortage, and payment models that are often inadequate. The COVID-19 pandemic has further exposed vulnerabilities and remains a threat to the future of primary care.

The purpose of primary care research is to better understand and improve the design, function, delivery, and outcomes of primary care. Primary care research has been and will continue to be critical if primary care is to evolve and thrive. As the designated federal agency to lead primary care research, the Agency for Healthcare Research and Quality (AHRQ) has been committed for the past 30 years to conducting and supporting primary care research and working to ensure that primary care research findings are understood and integrated into practice. In 1990, AHRQ (in its previous incarnation as AHCPR—Agency for Healthcare Policy and Research) sponsored a national conference entitled Primary Care Research: An Agenda for the 90's, which produced a summary report and primary care research agenda centered on the patient, the practitioner, the problem, and the clinical process of care as they exist and interact with the social structure, the community, practice or program, and healthcare system.⁴ This agenda specifically defined research needs related to the organization of primary care, evolving financial models for primary care, care for patients with complex medical presentations, and equitable primary care for all Americans. The need for the training and professional development of primary care researchers was also emphasized (Table 1).

Table 1. 1990 Primary Care Research Agenda

Despite name changes and restructuring, the Agency has consistently invested in primary care research since 1990. Under the Omnibus Budget Reconciliation Act (H.R. 3299, section 6103), AHRQ's predecessor, ACHPR (1989–1999), quickly established an agenda to conduct and support primary care and practice-oriented research through the Division of Primary Care within the Center for General Health Services Extramural Research. Ten years later, upon congressional passing of the Healthcare Research and Quality Act, AHCPR was renamed AHRQ and specifically designated as the lead federal agency for primary care research and mandated to house a center for primary care research. From 1999–2014, primary care research was housed in the Center for Primary Care, Prevention, and Clinical Partnerships (CP3). Then in 2014, CP3 was merged with the Center for Outcomes and Evidence to form the Center for Evidence and Practice Improvement (CEPI) and a formal National Center for Excellence in Primary Care Research (NCEPCR) was established within CEPI (Figure 1).

Figure 1. Evolution of Primary Care Research at the Agency

Thirty years following the initial primary care research conference, AHRQ convened a second national conference to develop a primary care research agenda for the 2020s and beyond. As part of this process, AHRQ conducted a review of the Agency's 30-year commitment to advancing the science of primary care delivery, specifically taking stock of the many impacts achieved along the way. This report describes AHRQ's investment in primary care research over three decades, from 1990–2020, and discusses how that research has impacted the field of primary care.