 CONTEXTE: LAgence de la santé et des services sociaux de Montréal ASSS invited our research team to evaluate the implementation of an integrated and interdisciplinary primary care network for prevention and management of cardiometabolic risks diabetes and hypertension PCR. The intervention is based on the Chronic Care Model and the development of an integrated services network. PCR is to be implemented in 6 territories of Centre de santé et de services sociaux CSSS. A first application for funding was made to Fonds Pfizer-FRSQ-MSSS for an evaluation that has to be completed in the first 24 month after the beginning of the implementation. This application to the PHSI program at CIHR is complementary and will ensure an evaluation of the sustainability of PCR and of long term effects 40 months after the beginning of the implementation for patients and for their primary care physicians. 