Dix-Hallpike maneuver performed for PATIENTS with BPPV

Measure Purpose: Ensure BPPV is diagnosed and first line treatment provided promptly

The numerator: Patients who had a Dix-Hallpike maneuver performed

is divided by

The denominator: patients diagnosed with BPPV

Exclusions are removed from the denominator for:

• Patient previously diagnosed with BPPV and who on date of encounter in calendar year does not have positional dizziness or vertigo consistent with active BPPV
• Patient has refused or declined Dix-Hallpike maneuver
• Patient has cervical spinal disease (i.e., cervical stenosis, severe kyphoscoliosis, limited cervical range of motion, Down’s syndrome, severe rheumatoid arthritis, cervical radiculopathies, Paget’s disease, ankylosing spondylitis, low back dysfunction, spinal cord injuries, spinal fractures)
• Patient unable to lay flat (i.e., severe heart disease)
• Patient has severe atherosclerotic disease or recent dissection involving the anterior or posterior cerebral circulation.
• Unable to be seated in exam chair (i.e., morbidly obese), or maneuver cannot be safely performed given morbid obesity 

Key Phrases

Key phrases you should document to meet the measure include:

• "Dix-Hallpike performed"
• "Unable to execute Dix Hallpike due to comorbid condition"
• "Patient refuses (or declines) Dix-Hallpike"

Measure Calculation Example

Dr. Silva sees 100 patients between January 1 and December 31 that were diagnosed with BPPV. This is the denominator.

Six patients had co-morbid conditions (i.e., cervical stenosis, severe kyphoscoliosis, limited cervical range of motion, Down’s syndrome, severe rheumatoid arthritis, cervical radiculopathies, Paget’s disease, ankylosing spondylitis, low back dysfunction, spinal cord injuries, spinal fractures, or morbid obesity) preventing Dix-Hallpike performance. Three patients refused or declined the Dix-Hallpike. Four patients were seen with a primary diagnosis of BPPV who were not currently experiencing positional dizziness. These 13 patients (6+3+4) are removed from the denominator as exclusions.

Of the 87 remaining patients, 61 had the Dix-Hallpike performed.  This is the numerator.

Quality of patient care = 61/(100-13). Dr. Silva has a score of 70.1% for this measure.