Primary care is the front door to the health system, where people first seek support for their physical, mental, and social health needs. It is defined by continuous, comprehensive, person-centred care delivered through relationships of trust and accountability, and by its role in coordinating services across health and social sectors to improve population health and equity.
Primary care is often discussed alongside primary health care, a broader approach that integrates public health, community participation, and multisectoral action to address the social determinants of health. In our Lab, we use “primary care” broadly to include both first-contact clinical care and primary health care initiatives that incorporate health promotion, community development, and equity-oriented system design.
Despite its essential role, Canada is facing a significant primary care crisis. According to the Canadian Institute for Health Information, 5.7 million adults lack a regular primary care provider, with unattached patients disproportionately drawn from underserved and equity-deserving communities. These gaps reflect structural challenges—including workforce shortages and maldistribution, rising patient complexity, and inconsistent policy approaches—and have contributed to Canada ranking last among high-income countries for timely access to primary care. Strengthening primary care is therefore essential to delivering accessible, coordinated, and equitable care across the health system.
The Integrated Primary Care Systems Lab is dedicated to transforming primary care into an equitable, high-performing, and accountable foundation of the health system. Led by Dr. Monica Aggarwal, an award-winning primary care and health services researcher, the Lab translates complex evidence into practical policy solutions that improve access, strengthen quality, and improve population health.
Our mission is to close the persistent gap between knowledge and implementation by advancing research that is embedded in real-world system improvement efforts. We work with policymakers, clinicians, community organizations, academic partners, and patient collaborators to build durable policy and system change.
The Lab was founded to address a recurring challenge in primary care reform: promising innovations rarely scale, policies often operate in silos, and decisions affecting millions are made without timely, actionable evidence. Over time, the lab has grown through continuous learning, institutional support, and a shared commitment to research excellence—strengthening its role in the university’s academic ecosystem.
Dr. Aggarwal’s seminal Milbank Quarterly work—providing the first decade-long assessment of Canadian reforms—revealed major gaps in governance, equity-focused planning, accountability, and workforce readiness. She subsequently co-developed the Aggarwal-Hutchison Framework, the first empirically grounded model detailing 13 core attributes of high-performing primary care systems. That framework is now foundational to Canadian policy and informs national standard-setting efforts.
The Lab grew from this work to become a space where evidence is not only produced but mobilized.
The Lab was founded to address a recurring challenge in primary care reform: promising innovations rarely scale, policies often operate in silos, and decisions affecting millions are made without timely, actionable evidence. Over time, the lab has grown through continuous learning, institutional support, and a shared commitment to research excellence—strengthening its role in the university’s academic ecosystem.
Dr. Aggarwal’s seminal Milbank Quarterly work—providing the first decade-long assessment of Canadian reforms—revealed major gaps in governance, equity-focused planning, accountability, and workforce readiness. She subsequently co-developed the Aggarwal-Hutchison Framework, the first empirically grounded model detailing 13 core attributes of high-performing primary care systems. That framework is now foundational to Canadian policy and informs national standard-setting efforts.
The Lab grew from this work to become a space where evidence is not only produced but mobilized.
Our mission is to make high-performing primary care systems achievable and sustainable by delivering:
We strive toward the Quintuple Aim—better population health, improved patient experience, lower costs, enhanced provider well-being, and health equity—as the standard for system success.
Co-Design and partnership: Our research programs engage policymakers, community partners, patient collaborators, and health system leaders as equal contributors—from question formation to implementation.
Methodological rigour: We use mixed-methods designs that combine comparative policy analysis, qualitative inquiry, quantitative and administrative data, consensus methods, and implementation evaluation.
Equity-first system design: Our work prioritizes communities facing structural barriers, including racialized, immigrant, LGBTQ2S+, low-income, language-minority, and housing-insecure populations.
Translation into practice: We specialize in applied frameworks, evaluation tools, standards development, and policy guidance that decision-makers can adopt immediately.
Our current portfolio spans multiple interrelated system-level domains:
Our work produces conceptual frameworks, national standards, evaluation models, commissioned reports, and publications used by governments, national bodies, and community partners.
The Lab collaborates extensively with organizations that shape Canadian health policy and delivery, including:
Our collaborations extend internationally through collaborative work with researchers and system leaders in the United Kingdom, Australia, and other jurisdictions.
Our outputs have:
Dr. Aggarwal’s research has been recognized through invited keynote lectures and selection as one of Canada’s Top 10 research papers for its contribution to equity in academia.
Dr. Aggarwal’s research has been recognized through major national awards, including Article of the Year, invited keynote lectures, and selection as one of Canada’s Top 10 papers for its contribution to equity and policy reform.
We collaborate with scholars, policymakers, providers, advocacy groups, and patient-partner leaders who share a commitment to actionable reform.
Whether advancing a research program, co-developing policy frameworks, designing evaluations, or training the next generation of leaders, the Lab’s work offers meaningful opportunities to drive system change.
The Aggarwal-Hutchison Framework defines the structural attributes of high-performing primary care systems and provides the analytic foundation for our work. We use the framework to guide research design, evaluation, and knowledge translation across our projects. Click through each element to learn more.
