Beyond Service Volume: Validating the Trajectories of Care Metric for Long-Term Veteran Referral Success

While health and human service referral networks are a common policy intervention to address siloed care, there is a pressing need for effective metrics to evaluate long-term client outcomes beyond simple service volume or resolution rates. This work, through three studies, introduces and validates the Trajectories of Care metric, a systems-based approach to evaluating client pathways and changes in the acuity of social needs over time. Drawing from a sequential confirmatory mixed-method design, Study 1 establishes a typology of social needs—categorized as basic, stressors, and nonessential—through interviews and surveys with providers. Study 2 develops the metric through a co-design process with care navigators, and Study 3 validates it using data from over 59,000 veteran clients across two national networks. Findings indicate that the metric effectively captures distinct constructs of client well-being. The results also reveal significant disparities in care trajectories based on gender, race, and military service era. This research provides a client-centered framework for referral networks to transition from managing service outputs to monitoring long-term improvement in client well-being. Future research is needed to investigate the impact of specific referral sequences and to develop clear guidelines for using these metrics to reduce systemic disparities in care.