Advancing Care Coordination Project

2019 Advancing Family-Centered Care Coordination for CYSHCN using a Shared Plan of Care QI Project

The Medical Home Initiative of Children's Health Alliance of Wisconsin is supporting implementation of quality improvement grants designed to support work with Wisconsin pediatric primary care teams to advance medical home care provision for children and youth with special health care needs through the use of a Shared Plan of Care.

A Shared Plan of Care is a living document completed by parents and health care providers that includes information necessary to assure issues affecting a child's health are identified and accessible across systems, and that activities and accountability for addressing those activities are documented. Key components include:

  • Medical summary
  • Family strengths and preferences
  • Negotiated plan of action (including clinical and family goals, actions to address goals, responsible partners, and timelines)
  • Other necessary attachments (such as emergency plans, chronic condition protocols, and relevant legal documents such as IEPs or 504 plans)

Learning Community Information

Learning Community Calls

(all calls 12-1pm)

  • February 26, 2019
  • June 25, 2019
  • October 22, 2019

Family Representative Calls

(all calls 7-8pm)

  • March 5, 2019
  • June 12, 2019
  • October 10, 2019



2018 Project

2016-2017 Shared Plans of Care Project Summary
A summary of the 2016-2017 projects using Shared Plans of Care to improve care for Wisconsin children and youth with special health care needs.


Learning Community Information


Learning Community Calls

4th Tuesday of even months (12:00-1:00pm):


Shared Plan of Care Examples

2018 QI Projects Summit
April 24, 2018

A day-long summit where information was shared to learn more about Shared Plans of Care, the Care Coordination Measurement Tool, Plan-Do-Study-Act cycles, and focus-area activities, as well as networking with professionals and families. Keynote speaker Dr. Jill Rinehart, M.D., F.A.A.P., from Vermont, discussed best practice use of Shared Plans of Care.



2017 Project

2016 Project

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