Complex Care Has Arrived

It is with great pleasure that we present the August 2020 issue of Hospital Pediatrics dedicated to the care of children with medical complexity, also known as complex care.

The past decade has been characterized by an increasingly detailed understanding of the impact of children with medical complexity on the inpatient setting. Children with complex chronic conditions account for ∼10% of US pediatric hospital admissions, ∼25% of pediatric hospital days, and ∼40% of pediatric hospital charges.¹  Children with complex chronic conditions are increasing in prevalence over time as well as complexity.²  Children with complex chronic conditions experience wide variation in care³  (see the Supplemental Figure 1). The need to optimize evidence and identify best practices for this growing patient population is evident to many pediatric providers in inpatient and outpatient settings alike.

In recognition of the importance of complex care, the editorial board issued a call for manuscripts for this special issue starting in September 2019. It is an understatement to say we were excited and thrilled by the response we received; ∼25 paper submissions were completed by the end of March 2020. Equally impressive was the response of the complex care community to provide reviewer feedback for so many paper submissions. By my imperfect count, ∼70 individuals agreed to perform ≥1 review in April and May of 2020, a short time period that happened to coincide with the COVID-19 pandemic. The commitment demonstrated by the complex care community as a whole is truly inspired.

I hope you share my enthusiasm for this remarkable issue. We saw incredible variety in the manuscripts submitted, reflecting a dynamic emerging field. The original science articles in this issue run the gamut from clinical tools, including a differential diagnosis tool to aid with clinical assessment of pain in children with medical complexity,⁴  to development of an app to facilitate patient care for children with medical complexity.⁵  No issue dedicated to children with medical complexity would be complete without an exploration of current gaps in care, and our authors have provided original science on issues ranging from medical record documentation⁶  to discharge medication education⁷  and discharge communication practices,⁸  as well as feedback from home health care providers.⁹  We also received reports describing and evaluating care models for children with medical complexity,^10,11  as well a health services research report.¹²  Included in this issue are valuable perspectives on a recent national initiative to improve care for children with medical complexity,¹³  as well as perspectives on the role of complex care in pediatric hospital medicine.¹⁴  Authors of additional perspective pieces suggest opportunities to improve care for children with medical complexity.^15,16 

Given the robust interest in complex care and the tremendous response we received to the call for submissions, we are delighted to report that we plan to publish ≤2 complex care articles in each issue of Hospital Pediatrics. We eagerly await your original science submissions and are excited to watch how complex care providers and families will advance care for children with medical complexity in inpatient and outpatient settings in the next decade.