of the original disease orlonger-term complications. Thesecond level captures new healthproblems created as a consequenceof treatment. When recurrencesor new illnesses occur, all outcomes must be remeasured.With some conditions, such asmetastatic cancers, providers mayhave a limited effect on survivalor other Tier 1 outcomes, but theycan differentiate themselves inTiers 2 and 3 by making caremore timely, reducing discomfort,and minimizing recurrence.Each medical condition (orpopulation of primary care patients) will have its own outcomemeasures. Measurement effortsshould begin with at least oneoutcome dimension at each tier,and ideally one at each level. Asexperience and available data infrastructure grow, the number ofdimensions (and measures) canbe expanded.Improving one outcome dimension can benefit others. Forexample, more timely treatmentcan improve recovery. However,measurement can also make explicit the tradeoffs among outcome dimensions. For example,achieving more complete recovery may require more arduoustreatment or confer a higherrisk of complications. Mappingthese tradeoffs, and seekingways to reduce them, is an essen