Learning Communities

A collaborative approach that encourages participants to share their work, discuss ways to improve, and learn from one another. The Medical Home Initiative provides support and technical assistance to two quality improvement projects, or learning communities. Within the communities there are structured goals that guide the work. Individual teams have the ability to take unique approaches within the community to best meet their needs and achieve desired outcomes.

Care Coordination Project

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

The Medical Home Initiative is supporting implementation of quality improvement processes designed to support work with Wisconsin health care teams and Tribal Health Centers 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 created by parents and health care providers. It includes information that ensures 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 of a Shared Plan of Care 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)

2020 Shared Plan of Care Learning Community
2020 Project Timeline

Learning Community Calls
All calls are from 12:00 p.m. – 1:00 p.m.

Family Representative Calls
All calls are from 7:00 p.m. – 8:00 p.m.

  • March 3
  • June 10
2020 Project Team Map

2020 Project Team Map

Wisconsin Clinics and Tribal Health Centers participating in the project

Shared Plan of Care Project Summary 2016-2017

Shared Plan of Care Project Summary 2016-2017

A brief summary of the work in Wisconsin from 2016 and 2017.

    For more information about grant opportunities or the Shared Plan of Care Project, please contact Colleen Lane.

    2019 Project Team Map

    2019 Driver Diagram

    2019 Learning Community Calls

    All calls are from 12:00 p.m. – 1:00 p.m.

    Developmental Screening Project

    Developmental Screening National Performance Measure

    The Medical Home Initiative is supporting local public health departments and tribal agencies focusing on the developmental screening national performance measure. Agencies have the option of selecting one or more of the following focus areas: medical providers, child care providers or community groups.

    MCH Objective Map

    MCH Objective Map

    2020 MCH Objective - Developmental Screening Map

    Driver Diagram

    Driver Diagram

    2020 Developmental Screening Quality Improvement Project

      2020 Learning Community Calls
      All calls are from 9:00 a.m. – 10:00 a.m.

      For more information about the Developmental Screening Project, please contact Naomi Kowald.

      2019 MCH Objective Map

      2019 Driver Diagram

      2019 Learning Community Calls

      2018 MCH Objective Map

      2018 Driver Diagram

      2018 Learning Community Calls

      Life QI: Quality Improvement Platform

      The Wisconsin Medical Home Initiative provides all 2019 project teams with access to Life QI. This online platform enhances the learning community experience by helping members collaborate, learn and share with different project teams throughout the year.

      Life QI allows project teams to:

      • Submit and visualize PDSA cycles
      • Monitor progress towards goals
      • Communicate and connect with Medical Home staff and other project teams
      • Discuss and share best practices and other information

      For more information on Life QI, or for help logging in, please contact us.

      Log In

      Contact Our Staff

      Colleen Lane
      Project Manager
      Medical Home
      (608) 442-4177

      Naomi Kowald, CAPSW
      Project Manager
      Medical Home
      (608) 442-4176

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      Monthly news, events and resources from the Wisconsin Medical Home Initiative.

      The Wisconsin Medical Home Initiative is funded by the Wisconsin Department of Health Services’ Title V Children and Youth with Special Health Care Needs Program and the Maternal Child Health Program located in the Division of Public Health.

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