Study setting 
This study was performed within the Division of Pulmonary and Sleep Medicine at CHOP, which consists of a care network in an urban environment composed of a tertiary care hospital and ambulatory pediatric subspecialty care centers located within the main campus in the city of Philadelphia as well as subspecialty care centers throughout the Greater Philadelphia area and New Jersey suburbs. The practice includes general pediatric pulmonary medicine as well as subspecialty programs in aerodigestive medicine, asthma, bronchopulmonary dysplasia, cystic fibrosis, lung transplantation, interstitial lung disease, primary ciliary dyskinesia, sickle cell disease, sleep medicine, and technology dependent children. The division’s healthcare providers included 29 pediatric pulmonologists (11 of whom also practice sleep medicine), 7 advanced practice providers, 5 psychologists (all from the sleep medicine program), 7 pulmonary fellows, and a team of registered nurses, social workers, dietitians, respiratory therapists, and medical assistants.