Evaluating and Strengthening NP-Led Primary Care Models in Ontario:A Co-Designed Framework for Meaningful Indicators

Canada’s health systems are under increasing strain from workforce shortages, rising costs, and inequitable access to primary care. In Ontario, Nurse Practitioner-Led Clinics (NPLCs) represent a promising but under-investigated model of team-based primary care that integrates interprofessional collaboration, digital health tools, and community-based service delivery to improve access, quality, and efficiency.
Despite more than a decade of operation, evidence on the performance, sustainability, and system-level impact of NPLCs remains fragmented compared to other models such as Family Health Teams (FHTs) and Community Health Centres (CHCs). Existing indicators are inconsistent and fail to capture the distinctive contributions of NP-led models—particularly their role in improving access and outcomes for marginalized and unattached populations.
This Catalyst Grant establishes the groundwork for a comprehensive, co-designed evaluation of NP-led primary care in Ontario. It focuses on identifying and defining meaningful indicators that reflect the unique value and outcomes of NPLCs. Using a Participatory Action Research (PAR) methodology, the project will engage Executive Directors and clinical leaders from three NPLCs in the Ottawa–Eastern Ontario region as co-researchers in all phases—from framing questions and interpreting findings to developing policy-relevant outputs.
By co-producing the approach to measurement with those most embedded in NP-led care, indicators will be contextually grounded, feasible to capture using existing data systems (e.g., ICES, HQO), and actionable for decision-makers. The resulting scoping review, data mapping, and feasibility assessment will inform a larger-scale evaluation of NPLCs and strengthen their contribution to primary health care transformation.
This proposal responds directly to CIHR-IHSPR’s Catalyst Grant call to accelerate discovery and implementation of workforce and digital innovations that transform primary-care delivery systems. It aligns with IHSPR’s strategic vision to achieve the Quadruple Aim with health equity at the core, advancing solution-oriented, co-produced research that improves system performance, patient and provider experience, and population-health outcomes.

Canada’s health care system is struggling. There aren’t enough health workers, costs are rising, and many people can’t find a primary care provider. In Ontario, Nurse Practitioner-Led Clinics (NPLCs) are a promising solution. They use teams of health professionals and technology to provide efficient, community-based care. However, we lack strong evidence to show how well they work compared to other types of clinics and models of care.

This project will lay the groundwork to find a meaningful way to measure NP care in team-based practices. We will partner directly with three NPLCs in Eastern Ontario to co-design a fair and practical way to measure the efficiency and value-based care that NPLCs. provide. Together, we will figure out what data to collect and how to use it to show the unique value of NPLCs.

This collaborative approach ensures the results will be useful for improving care and guiding government decisions. Our work will provide the foundation for a larger study, helping to create ways to measure NP care across provinces. Having a consistent way to measure care provided by NPs in a team-based setting will strengthen primary care for all Canadians.

1. Partnership building: Strengthen collaboration among Executive Directors of three NPLCs in Eastern Ontario, researchers, and policy partners.
2. Evidence synthesis: Conduct a rapid scoping review to identify existing performance frameworks and indicators used in NP-led and comparable primary care models.
3. Indicator co-design: Identify priority domains of performance and co-develop candidate indicators reflecting access, quality, efficiency, and equity.
4. Data mapping and feasibility: Assess alignment between proposed indicators and existing data holdings (ICES, HQO) to identify gaps and opportunities.
5. Validation and refinement: Achieve consensus on a feasible, equity-sensitive indicator set through iterative reflection and testing.
6. Knowledge translation: Produce actionable evidence briefs and a roadmap for province-wide scale-up.

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