Context: The National Academy of Medicine describes primary care (PC) as a set of integrated and accessible services that address a majority of personal healthcare needs provided by clinicians working in partnership with patients and in the context of community. Primary care research (PCR) is research that is conducted in a PC setting, by or about PC clinicians, or on a topic that is integral to PC. In 1989, Congress established the Agency for Health Care Policy and Research (AHCPR), authorizing it to conduct research in PC and practice-based settings. This authorization was reinforced in 1999 when the newly named Agency for Healthcare Research and Quality (AHRQ) established a center for primary care research to conduct and support PCR, which later become home to the National Center for Excellence in Primary Care Research (NCEPCR). As AHRQ launches a renewed research agenda for the NCEPCR, it has commissioned a review of the agency’s 30-year commitment to PCR.

Objectives: To review AHRQ’s PCR initiatives from 1989 to 2019, highlight the impact of these investments on the field of PC, and identify future directions.

Design/Outcomes: Descriptive review informed by: 1) seminal publications, reports, and program documents; 2) semi-structured interviews with key informants; 3) portfolio analysis of 2008-2019 grants; 4) conference presentations; and 5) NCEPCR website review. Key projects were highlighted from each era of PCR (1989-1999, 2000-2009, and 2010-2019) and within the themes of: organization of care, workforce, quality/safety, patient-centeredness, financing/cost, and cross-cutting themes such as methods, data, and digital healthcare. Impact of PCR findings and subsequent research, healthcare policies, clinical practice and tools/resources for practice, and health outcomes are described for each project.

Results: 30 projects (grants, contracts, and other initiatives) were identified, reviewed, and appraised for impact and 10 potential research directions were identified.

Conclusions: Although AHRQ has not received appropriated funding for PCR, nor the NCEPCR, the agency has consistently invested in research, methods, and tools that have driven innovation and changed practice. Many programs, such as Project ECHO and TeamSTEPPS, got their start with AHRQ. As the COVID-19 pandemic reveals the importance of PC to the nation’s health and threatens its continued existence, AHRQ remains committed to helping PC understand and adapt to new challenges.