A systems model is presented that has the potential to expand understanding of the complex nature of health-related outcomes The horizontal axis is a systems axis of context, process and outcome and the vertical axis consists of the client, provider and setting Examples from outcome research in Latin America and the Caribbean are provided Each section is explored from the perspective of primary health care research and some of the issues of design, measurement and analysis are raised The systems model is offered as a framework for conceptualizing research on the impact of nursing care on client, provider and setting outcomes