Introduction: Special Considerations in the Care of Children with Medical Complexity

Children with medical complexity (CMC) make up a particularly vulnerable subset of pediatric patients. These are patients with at least one chronic medical condition that is severe or contributes to significant morbidity and/or mortality [1]. They are high utilizers of the healthcare system, often requiring several medications, technology (e.g., feeding tubes, breathing tubes, or other assistive devices), and frequent visits with medical providers. Most pediatric residency programs lack dedicated curricula focused on teaching trainees to care for these medically complex patients. Thus, much of their care is provided by highly trained pediatric subspecialists in tertiary and quaternary care centers. However, many of these centers are far from the communities in which these children and families live. Although there has been an increase in the pediatric subspecialty workforce over time, the geographic distribution still favors urban areas with millions of children residing more than 90 min from their specialty providers [2]. Some of the burden of transportation to and from these centers has been alleviated by the increase in telehealth visits with pediatric subspecialists.