AHRQ’s National Center for Excellence in Primary Care Research (NCEPCR): A New Home for Primary Care Research

INTRODUCTION

The Agency for Healthcare Research and Quality (AHRQ) has supported primary care research for over 30 years.¹ In 1990, AHRQ (then the Agency for Healthcare Policy and Research) held a conference to set an agenda for primary care research designed to meet the challenges of the 21st century (Figure 1).² Since then, AHRQ has remained committed to conducting and funding primary care research and disseminating findings to the field. From fiscal years 2008 to 2019, almost 20% of all AHRQ-funded investigator-initiated research grants were primary care–related.³ In addition, AHRQ has invested in building the primary care research infrastructure and workforce; developing research methods, tools, and resources; creating conceptual frameworks; and generating data. AHRQ has led initiatives on primary care practice transformation, improving the quality and safety of care, practice facilitation, practice-based research networks, and integrating behavioral health and primary care.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1.

Timeline of Primary Care Research at AHRQ

AHCPR = Agency for Healthcare Policy and Research; AHRQ = Agency for Healthcare Research and Quality; FY = fiscal year; NCEPCR = National Center for Excellence in Primary Care Research; PBRN = practice-based research network; R01 = Research to Advance the Science of Primary Care (PA-24-205); R03 = Research to Advance the Science of Primary Care (PA-24-205)

Congress authorized AHRQ to establish a center for primary care research in 1999, but did not appropriate funds for this purpose.³ AHRQ formalized the National Center for Excellence in Primary Care Research (NCEPCR) in 2014; however, the continued lack of dedicated funding limited the agency’s ability to staff, support, or grow the center, leaving primary care–related research dispersed across AHRQ’s centers and difficult to recognize as a unified portfolio. Recognizing the need for a more strategic approach, AHRQ appointed NCEPCR’s first full-time director in 2021, laying the groundwork for its first $2 million in Congressionally earmarked funding per year starting in fiscal year 2022. NCEPCR now serves as the home for primary care research at AHRQ while continuing to work closely with the other AHRQ centers to advance primary care research. The majority of the agency’s funding for primary care–related grants and contracts, which has totaled approximately $110 million annually in recent years,⁴ comes from agency funds other than NCEPCR’s $2 million earmark, including the Patient-Centered Outcomes Research Trust Fund-PCORTF, General Health Services Research appropriations, Patient Safety appropriations, and Digital Healthcare Research appropriations.

This special report in Annals of Family Medicine aims to increase the awareness of AHRQ’s NCEPCR among primary care clinicians, researchers, and partners, by highlighting NCEPCR’s initiatives to improve research, practice, and workforce development in primary care to benefit patients and clinical teams.

THE MISSION

NCEPCR aims to strengthen the nation’s primary care system by sponsoring research to generate the evidence, tools, and other resources that can be used by researchers, clinicians, and clinical teams, quality improvement experts, and health care decision makers in their efforts to improve the quality and safety of care. NCEPCR’s mission is to support transformative primary care research, tools, and methods for implementation, and the next generation of primary care researchers to improve the delivery of primary care.⁵ Ultimately, NCEPCR envisions a future where all patients receive high-quality, whole-person, evidence-based, affordable primary health care from a healthy primary care workforce.⁵

BUILDING AHRQ’S HOME FOR PRIMARY CARE RESEARCH

Over the past 3 years, NCEPCR has been working to define its mission and vision, establish goals, and curate and coordinate a primary care research portfolio and agenda across the agency. As part of this mission and vision-setting agenda, NCEPCR engaged partners including researchers, clinicians, and primary care policy experts from around the country to help bring an outside perspective to internal planning and discussions. As described more fully elsewhere,⁴ partners recommended that NCEPCR focus efforts on bringing together key primary care research entities, disseminating relevant resources and materials to the field, bolstering primary care research infrastructure, and funding more research focused on workforce and health equity.

An early accomplishment was developing a new NCEPCR website to bring together agency-wide content related to primary care research.⁶ The website shares information about AHRQ’s primary care research–related initiatives; relevant tools and resources, including data resources; primary care–relevant reports and publications; and funding opportunities. The NCEPCR webpages received over 7.5 million views from 4.8 million users in 2024. There are currently over 60 resources hosted on this website that focus on topics including quality improvement, care management and coordination, integrating behavioral health in primary care, practice facilitation, and digital health. Over a 1-year period, these resources alone had almost 134,000 views on the website. NCEPCR has also compiled 6 AHRQ data sources containing primary care–relevant data on its website for easy access. The NCEPCR website hosts a newly updated Practice-Based Research Network (PBRN) Registry with 130 active PBRNs, as well as a set of interactive training modules designed to assist practice facilitators in gaining critical skills to work with primary care practices to make meaningful changes and improve patients’ outcomes.

NCEPCR also created a comprehensive compilation and review of AHRQ’s portfolio of primary care research as one of its many initial efforts as the primary care research hub at AHRQ. This has resulted in 2 reports: one reviews AHRQ’s 30-year investment in primary care research, between 1990 and 2020¹; and the other examines AHRQ’s more recent investments for 2021 and 2022.⁴ The analysis of recent investments found that AHRQ had a total of 140 active primary care research projects during fiscal years 2021 and 2022, including 128 grants and 12 contracts. The grants were distributed across 66 institutions located in 30 states across the country and have resulted in over 500 publications to date. Many of these grants focused on digital health care and practice and quality improvement, while fewer focused on behavioral health or the primary care workforce.

NCEPCR has hosted 2 webinar series to further disseminate primary care research findings and insights. One series of 7 webinars highlights AHRQ-funded research studies with diverse methodological approaches that have strengthened primary care research and delivery across various focus areas.⁷ Another series is designed to support the work of PBRNs, and features learnings from experienced PBRN leaders in 2 webinars and an asynchronous e-learning course.⁸

To help spur innovative and rigorous primary care research, NCEPCR has issued funding announcements targeted toward advancing the science of primary care. First, an R03 (Small Research Projects to Advance the Science of Primary Care [PA-23-115]) was released in January 2023 (to date, 4 projects have been awarded), followed by an R01 (Research to Advance the Science of Primary Care [PA-24-205]) released in March 2024 (the first applications received for this opportunity are still under review). These funding opportunities have garnered much interest among the primary care research community, as indicated by number of communications with the scientific research contact and number of applications received to date. Additionally, NCEPCR has funded a contract to support partner engagement and dissemination, and a contract to revitalize AHRQ’s support of PBRNs, both of which have resulted in a series of public and behind-the-scenes actions and outputs to move the NCEPCR mission forward.

NCEPCR is committed to supporting and expanding a primary care research workforce that is varied in a number of ways, including by career phase/years of experience, race/ethnicity, medical specialty or academic discipline, methodological training, area of expertise or clinical focus within primary care, and topic of research interest. A Special Emphasis Notice released in 2021 supports career development for emerging primary care researchers.⁹ Of the primary care research grants awarded in 2021-2022, 10% were career development awards. In addition, each year NCEPCR hosts fellows from AHRQ’s Junior Staff Service Fellow Program to work on primary care–related projects at AHRQ (5 fellows have participated to date),¹⁰ and in fall 2024, NCEPCR began cohosting a health policy fellow with the Robert Graham Center. NCEPCR also encouraged principal investigators with existing awards to apply for AHRQ’s Competitive Revision Supplements to Existing AHRQ Grants and Cooperative Agreements to Enhance Workforce Diversity in Health Services Research, but this supplement has now expired.¹¹

Finally, NCEPCR is working to enhance opportunities for collaboration with other Health and Human Service (HHS) agencies by leading a newly established HHS Primary Care Research workgroup, established to maintain the momentum created by the HHS Initiative to Strengthen Primary Care.¹²

CURRENT CHALLENGES

NCEPCR recognizes several challenges in the field of primary care research that make it difficult to accomplish its mission. First, the low level of federal spending on primary care research overall,¹³ and the budgetary constraints of a small NCEPCR budget specifically, limit a robust federal primary care research agenda. Second, the lack of a standard, operationalizable definition of primary care that captures services, providers, and settings repeatedly confounds researchers trying to accurately measure spending on primary care in the United States, understand the extent of the primary workforce shortage and its distribution, and understand how access to high quality primary care impacts patient outcomes.¹⁴ Third, data limitations and fragmentation, including a lack of accurate, accessible, standardized, national-level data (claims, electronic health record, etc) constrain the ability to conduct rigorous, meaningful, actionable research about elements unique to primary care.¹⁵ Finally, the continuing decline in the primary care workforce, along with shifting practice ownership models,¹⁶ adds restrictions and burdens on clinicians participating in research and on researchers conducting research in primary care settings.

LOOKING TO THE FUTURE

Despite the challenges, to achieve its mission and vision and address the external partner recommendations, NCEPCR plans to focus on 6 main types of activities: Coordinate, Curate, Communicate, Cultivate, Convene, and Catalyze (Figure 2).⁵ Looking forward, NCEPCR will coordinate and support the collaboration of primary care research across all HHS agencies. To do this, NCEPCR plans to curate primary care relevant information, evidence, methodologies, instruments, measures, and data sets and communicate these to the field through ongoing dissemination efforts. For example, NCEPCR is currently developing a new resource to help researchers identify data sources relevant to a variety of research questions.

• Download figure
• Open in new tab
• Download powerpoint

Figure 2.

NCEPCR Activities

AHRQ = Agency for Healthcare Research and Quality; HHS = US Department of Health and Human Services; NCEPCR = National Center for Excellence in Primary Care Research.

To cultivate a robust primary care research workforce, NCEPCR will continue to offer funding opportunities to primary care researchers of all experience levels, including those early in their careers with dissertation grants and career development grants. NCEPCR will also continue to host fellowships for early career primary care researchers, and support PBRNs with a PBRN Registry as well as tools and resources.

In addition, NCEPCR will periodically convene the individuals and groups most invested in primary care research (including those from both private and public organizations and federal, state, and local sectors and patient and community-based organizations). These convenings could include a variety of webinars, seminars, meetings, and conferences to gather input from the broader primary care community regarding a primary care research strategy and would help accelerate the dissemination and implementation of evidence into practice. NCEPCR also hopes to develop virtual collaboration spaces to help build primary care research communities.

NCEPCR will catalyze new and innovative primary care research, by funding investigator-initiated primary care research. The center plans to invest in research topics our partners have identified as areas for additional focus, such as health access and strengthening the health workforce.

Building on its early successes, NCEPCR plans to continue to grow, fostering collaborative relationships with federal and private sector partners and helping to coordinate a unified primary care research agenda across HHS. With increased funding and staffing in the future, NCEPCR can more meaningfully and sustainably engage in efforts toward achieving its mission and vision—to build a robust federal primary care research endeavor that leads to a future where all patients receive high quality, whole-person, evidence-based, affordable primary health care from a healthy primary care workforce.