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Measure Purpose: Ensure patients with posterior canal BPPV have therapeutic canalith repositioning procedure (CRP) performed or referred to a qualified provider

The numerator: Therapeutic CRP performed or referred for physical therapy or to a
provider who can perform CRP

is divided by

The denominator: patients diagnosed with posterior canal BPPV 

Exclusions are removed from the denominator:

• Patient has refused or declined CRP
• 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., congestive heart disease with supine dyspnea)
• Patient unable to be seated in exam chair (i.e., morbidly obese) 

Key Phrases

Examples of key phrases you could use to meet the measure include:

• "CRP (or Epley maneuver or Semont maneuver) performed"
• "Patient referred to physical therapy for CRP"
• "Referred patient for CRP"
• "Unable to execute CRP due to comorbid condition"
• "Patient refuses (or declines) CRP"

Measure Calculation Example

Dr. Zhang has 100 patients between January 1 and December 31 that were diagnosed with posterior canal BPPV. This is the denominator.

Ten 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 CRP performance. Two patients refused or declined CRP.  These 12 patients (10+2) are removed from the denominator as exclusions.

Of the 88 remaining patients, 65 had CRP performed.  This is the numerator.

Quality of patient care = 65/(100-12). Dr. Zhang has a score of 73.9% for this measure.