# DIZZiness Treatment through ImplementatioN & Clinical strategy Tactics (DIZZTINCT-2) Project

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2020 · $686,155

## Abstract

Project Summary/ Abstract
Dizziness in the emergency department (ED) is a common problem with many opportunities to implement
efficient and evidenced-based practices. In DIZZTINCT-1, we developed and evaluated an implementation
strategy that focused on increasing the performance of the Dix-Hallpike test (DHT) and canalith repositioning
maneuver (CRM) in the ED by applying a benign paroxysmal positional vertigo (BPPV) -centric approach. We
found that the strategy substantially increased DHT and CRM performance. In implementation fidelity
interviews, providers who started using the DHT and CRM typically reported positive experiences, as reflect by
the following quote: “He immediately felt better and walked out about 20 minutes later…it was awesome.”
There was also a decrease in the use of head CTs, which are typically unnecessary with a BPPV-centric
approach. Importantly, the decrease in head CTs did not lead to an increase in stroke misdiagnosis.
DIZZTINCT-1, however, is limited in its potential to scale-up because it used investigator led education
sessions, cash incentives, and did not have adequate engagement at nonacademic facilities. We learned
about important revisions to the strategy that could increase generalizability and more routine provider use,
particularly at nonacademic EDs. In DIZZTINCT-2, we will enhance and refine the strategy in four ways. First,
the education sessions will be more generalizable because we will utilize local providers and an online CME
program. Second, we will broaden the target providers to include nurses since we learned that nurses can play
a major role in implementing the BPPV-centric approach. Third, we will respond to provider requests to expand
the topic to include best practices for assessing stroke risk in dizziness visits and evidence-based diagnosis &
management for vestibular neuritis. Expanding the topic could both increase exposures to the BPPV-centric
resources and create more opportunities for best practices. Fourth, we will add patient-oriented resources,
which also responds to providers’ requests and increases opportunities for best management. For DIZZTINCT-
2, we have partnered with Kaiser Permanente Southern California (KPSC) to test the strategy. KPSC has 12
EDs and ~40,000 annual dizziness visits. DIZZTINCT-2 will use a hybrid type 3 implementation-effectiveness
trial of a stepped wedge randomized trial for the ED implementation strategy and an embedded randomized
patient-level dissemination strategy. We have the following specific aims: Aim 1. To determine the impact of
the revised and enhanced BPPV-centric implementation strategy on DHT/CRM performance in dizziness visits,
at academic and nonacademic EDs, using a randomized stepped wedge design. Aim 2. To evaluate clinical
outcomes associated with the implementation strategy using both a stepped wedge ED-level strategy and an
embedded randomized clinical trial of a patient-level dissemination strategy. DIZZTINCT-2 is the first study to
a...

## Key facts

- **NIH application ID:** 9972032
- **Project number:** 2R01DC012760-06A1
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Kevin Anthony Kerber
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $686,155
- **Award type:** 2
- **Project period:** 2013-08-01 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9972032

## Citation

> US National Institutes of Health, RePORTER application 9972032, DIZZiness Treatment through ImplementatioN & Clinical strategy Tactics (DIZZTINCT-2) Project (2R01DC012760-06A1). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9972032. Licensed CC0.

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