Standard BPPV management

Measure Purpose: Ensure patients with BPPV receive optimal care

This is an inverse measure where a lower score is indicative of better quality.

The numerator has four components:

• Component A: Patients with BPPV referred for vestibular testing* by the encounter provider 
• Component B: Patients with BPPV referred, recommended, or ordered a CTA, CT, MRA, or MRI by the encounter provider
• Component C: Patients with BPPV prescribed antihistamine or benzodiazepine medication by the encounter provider
• Component D: Total patient performance on Components A, B, & C

Exclusions are required for patients whose diagnosis of BPPV was made after vestibular testing, imaging, or antihistamine or benzodiazepines prescribed.  Additional exclusions allowed for multiple scenarios. Please see measurement specifications for complete exclusion list. 

*See measure specifications for additional details

is divided by 

The denominator: patients diagnosed with BPPV

Key Phrases

Key phrases you should use to document this measure include:

• "Patient referred for vestibular testing (OR basic vestibular evaluation, caloric testing, VEMP testing, rotary chair testing, posturography, or video head impulse test)"
• "Patient referred for CTA (OR CT, MRA, or MRI)"
• "Ordered CTA (OR CT, MRA, or MRI)"
• "Patient prescribed antihistamine (or benzodiazepine)"

Measure Calculation Example

Dr. Baker has 100 patients between January 1 and December 31 of the measurement year that were diagnosed with BPPV.

Of the 100 patients, seven were prescribed a benzodiazepine and four received vestibular testing prior to the diagnosis of BPPV. These 11 (7+4) patients meet the required exclusion criteria and are removed from the denominator.

Of the 89 patients remaining, Dr. Baker ordered vestibular testing (Component A) for 17 patients, referred 9 patients for imaging (Component B), and prescribed an antihistamine or benzodiazepine (Component C) for 16 patients. 

For Component D, Dr. Baker had 17 unique patients ordered vestibular testing, 6 unique patients referred for imaging, and 10 unique patients prescribed an antihistamine or benzodiazepine. Three patients had both vestibular testing and imaging and six patients ahd both a prescription for antihistamine or benzodiazepine and vestibular testing. These patients are not counted twice.

Quality of patient care =

• Component A = 17/(100-11). Dr. Baker has a score of 19% for Component A.
• Component B = 9/(100-11).  Dr. Baker has a score of 10% for Component B.
• Component B = 16/(100-11).  Dr. Baker has a score of 18% for Component C.
• Component D = (17+6+10)/(100-11). Dr. Baker has a score of 37% for Component D.