The Triple Aim framework is an increasingly popular tool for designing and assessing quality improve-ments in the health care sector. We systematically reviewed the empirical evidence on the applicationof the Triple Aim framework within primary healthcare settings since its inception almost a decade ago.Results show that primary healthcare providers varied in their interpretation of the Triple Aim frameworkand generally struggled with a lack of guidance and an absence of composite sets of measures for perfor-mance assessment. Greater clarity around application of the Triple Aim framework in primary healthcareis needed, especially around the selection and implementation of purposeful measures from locally avail-able data. This review highlights areas for improvement and makes recommendations intended to guidefuture applications of the Triple Aim in the context of primary healthcare.