Addani, Mohamed

Background: Platelet-rich plasma (PRP) is an emerging therapy that demonstrates potential benefits for knee osteoarthritis (OA); however, the accessibility of PRP remains limited, in part, because its use is not covered by insurance. Purpose: To identify factors contributing to health disparities in PRP treatment for knee OA using machine learning models. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The authors collected data from electronic medical records at 2 upper Midwest medical centers (Mayo Clinic and Detroit Medical Center) from 2022 to 2023 encompassing demographic, socioeconomic, and clinical factors. Data collection encompassed age, sex, race, ethnicity, area deprivation index, marital status, income, rurality, insurance, employment, language, religion, treatment site, and region. Logistic regression and random forest models were applied to 3667 samples (80% training, 20% testing), comparing PRP recipients against a standard care group. Models were evaluated using 10-fold cross-validation to ensure robust performance assessment. Results: Logistic regression revealed that increased age, widowed status, lower income, rural residence, unemployment/disability, and Medicaid/Medicare insurance were associated with lower odds of receiving PRP. Upper-middle income, contracted insurance, and treatment at the Mayo-Arizona and Mayo-Florida sites were associated with higher odds. The model achieved areas under the curve of 0.83 (training set) and 0.82 (testing set). Random forest analysis identified distance to care, age, area deprivation index, income, and treatment site as top predictors, with areas under the curve of 0.92 (training) and 0.87 (testing). Conclusion: The current study demonstrated that both models discerned key barriers (income, distance to care, retirement status) and facilitators (regional differences) affecting PRP accessibility. These findings provide potential policy initiatives aimed at improving PRP access for underserved demographics, offering a quantitative blueprint to foster equitable access to regenerative therapies for knee OA.

Abstract Introduction Most US businesses offering unproven stem cell interventions (SCIs) are run by physicians, many of whom operate outside their scope of training. To date, little effort has been made to educate practicing physicians about SCIs. To circumvent the need, several businesses have begun advertising training opportunities for physicians. Objective To understand the current training landscape for physicians, we undertook a systematic content analysis of stem cell courses advertised on the internet. Methods We conducted Google searches using keywords and included onsite, online, and hybrid training programs targeting physicians or other clinicians. We systematically examined all information and identified 14 courses (6 onsite, 4 online, and 4 hybrid) offered by 11 different organizations. Courses ranged from single-day workshops to year-long programs with an average cost of $4,919 and ranged from $500 to $22,000. Results Nine courses listed a practicum component and ten courses listed 63 affiliated clinics, companies, and non-profit institutions. Eight organizations included learner testimonials as text and/or video with most authored by physicians and all expressed a positive tone. We analyzed marketing language used by training organizations that 6 of 14 explicitly mentioned offering assistance in marketing and/or revenue growth to learners. We also examined the backgrounds of physician faculty among organizations. Of the 7 businesses which listed faculty, a total of 172 faculty were found ranging from 4 to 71 individuals. Among the 172 faculty, 121 were physicians where we were able to determine whether they provided unproven, questionable or proven treatments within their practice. The majority of physician faculty (66%) were associated with unproven treatments, 21% offered proven treatments, and 13% offered questionable treatments. Nearly half the faculty (48%) provided 3-5 unproven therapies, 35% provided 1-2 unproven therapies, and 17% provided 6 or more unproven therapies. Conclusions Our results indicate that current pedagogical offerings for physicians interested in SCIs are likely to offer questionable training that is not rooted in evidence. Physicians interested in SCIs should seek training from nationally accredited organizations. The scientific community should invest in physician training surrounding SCIs. Disclosure No.