This research programme addresses the question: What are the steps to implementing innovative integrated community-based primary health care (CBPHC) models that address the health and social needs of older adults with complex care needs? The programme is directed at 4 levels of analysis: policy, organisation, provider, and patient and family/caregiver and will be conducted in 3 phases. Phase 1 identifies and describes successful integrated CBPHC models; Phase 2 involves in-depth case studies of exemplar models and creates a framework to explain conditions that lead to successful implementation; Phase 3 evaluates the implementation of innovative CBPHC models. Research methods include: reviews of official documents and databases and mixed methods case studies (including surveys, interviews, and analysis of administrative data). Key outcomes will be performance measures at the patient, provider, organisation and system levels, and a systematic guide to the design, implementation and scaling-up of innovative models of CBPHC.