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Policy: Clinical Care Statement Policy #: 1.

002 # Pages: 4 POLICY: It is the policy and practice of Catalyst Sports Medicine to follow the Clinical Care Statement for all patient care and patient education provided by Catalyst Sports Medicine employees and contract staff. Clinical care decisions will be patient-centered and reflect evidence-informed practice. This policys intent is to help ensure that Catalyst Sports Medicine clinical providers maximize the non-specific treatment effects of each patient encounter while simultaneously providing a hierarchy of science-based physical therapy interventions. Best practice at Catalyst Sports Medicine is defined as the consistent utilization of the highest level of clinical evidence available for a given patient condition. When clinicians utilize low level evidence interventions and techniques it will not be in the absence of higher level clinical evidence. POLICY STATEMENT AND STANDARDS: Catalyst Sports Medicine and its staff have set the following standards to ensure an exceptional customer experience with optimal clinical outcomes for all patients. Patients who choose Catalyst Sports Medicine will receive clinical care that is consistent and standardized across all providers at the lowest cost possible. Catalyst Sports Medicine will identify and meet the needs of all stakeholders in the delivery of healthcare services. Treatment effectiveness is achieved through non-specific and direct treatment interventions. Catalyst Sports Medicine policies are based on the desire to maximize the outcomes our patients achieve through a focus on both interventions. Catalyst Sports Medicine will achieve this goal of best practice through hiring the right staff, providing exceptional clinical resources and mentorship to for current staff, and abiding by the corrective action principles of Catalyst Sports Medicine should an employee require such intervention. In order to meet Catalyst Sports Medicine clinical standards, Catalyst Sports Medicine expects all licensed physical therapists to sit for the Orthopaedic ABPTS Board Certification within three years of their first date of hire at Catalyst Sports Medicine. 1. Physical therapists are provided financial assistance to sit for the board exam as outlined in the employee handbook. Effective/Revision Date: 11/01/12 Policy Classification(s): COM

Policy Updated 04.10.13- JWM

2. Failure to sit for ABPTS Board Certification within three years of Catalyst Sports Medicine employment is grounds for immediate termination from employment at the discretion of the Catalyst Sports Medicine Clinic Director. 3. Failure or repeated failure of ABPTS Board Certification testing is not grounds for termination from employment.

Standard #1: All Catalyst Sports Medicine employees and contract staff agree to use the Levels of Evidence Scale and Grades of Evidence Scale below to rank the level or grade of evidence available for a given intervention. Levels of Evidence Scale I II Evidence obtained from high quality diagnostic studies, prospective studies, or randomized controlled trials Evidence obtained from lesser-quality diagnostic studies, prospective studies, or, randomized controlled trials (eg, weaker diagnostic criteria and reference standards, improper randomization, no blinding, <80% follow-up) Case controlled studies or retrospective studies Case series Expert opinion


Grades of Evidence Grades of Recommendation A

Strength of Evidence A preponderance of level I and/or level II Strong evidence studies support the recommendation. This must include at least 1 level I study A single high-quality randomized Moderate evidence controlled trial or a preponderance of level II studies support the recommendation A single level II study or a preponderance of level III and IV studies including Weak evidence statements of consensus by content experts support the recommendation Higher-quality studies conducted on this topic disagree with respect to their Conflicting evidence conclusions. The recommendation is based on these conflicting studies A preponderance of evidence from animal or cadaver studies, from conceptual Theoretical/foundational models/principles, or from basic evidence sciences/bench research support this conclusion Best practice based on the clinical Expert opinion experience of the guidelines development team
Policy Updated 04.10.13- JWM

Standard #2: All Catalyst Sports Medicine employees and contract staff agree to consistently utilize the highest graded level of evidence over each patients episode of care. Standard #3: All Catalyst Sports Medicine employees and contract staff agree that the use of interventions with Level V, and Level V evidence will only occur in conjunction with interventions Levels I III and in situations whereby other higher ranked interventions do not exist in the peer-reviewed literature. Standard #4: All Catalyst Sports Medicine employees and contract staff will follow the approved Catalyst Sports Medicine clinical guideline protocols contained and updated within the Clinical Operations policy manual for the delivery of care. An attestation sheet will be signed by all clinical staff to ensure education and operational support is provided with all changes/updates in clinical care pathways in the manual. Standard #5: The Catalyst Sports Medicine Clinical Director has final approval authority for all clinical care pathways for Catalyst Sports Medicine. Standard #6: The determination of adherence with Catalyst Sports Medicine clinical care standards will occur through the following methods: 1) Catalyst Sports Medicine Clinic Director and/or his/her appointed staff will conduct regular chart audits to assess the extent to which all clinical staff are following Catalyst Sports Medicine clinical care standards; 2) Direct Observation by Clinical Director; 3) Verbal report from a Catalyst Sports Medicine peer or patient. A one on one interview will be conducted between the care provider and the Clinical Care Coordinator to determine the facts of a given clinical situation under review. Standard #7: In the event Catalyst Sports Medicine clinical care standards are not being met by a provider, Catalyst Sports Medicine Clinical Director will determine whether noncompliance was related to insubordination or opportunity for growth. In the situation of opportunity for growth, Catalyst Sports Medicine will educate the staff member on the proper protocol through a one on one personal meeting. The Clinical Director will provide clear expectations for future delivery of care and resources to educate the staff. Catalyst Sports Medicine does not consider this learning opportunity to be disciplinary action and the event will not be kept in the employees Human Resources file. Standard #8: In the event of Catalyst Sports Medicine clinical care standards are not being met related to insubordination, Catalyst Sports Medicine Management will follow the Catalyst Sports Medicine Positive Corrective Action System as outlined in the HR Policy Manual (3.0039). Standard #9: The following treatment interventions will not be provided by any Catalyst Sports Medicine employee or contract staff during time compensated by Catalyst Sports Medicine:

Policy Updated 04.10.13- JWM

1. Cranial Sacral Therapy 2. Visceral Manipulation 3. Other such pseudoscientific interventions. Pseudoscientific interventions are rehabilitation beliefs or practices that are presented as scientific, but do not adhere to a valid scientific method, lack supporting evidence or plausibility, cannot be reliably tested, or otherwise lack scientific status. 4. A treatments inclusion or exclusion in this standard will be reviewed during the annual update of this COM policy Catalyst Sports Medicine Staff Signature Date

Policy Updated 04.10.13- JWM