1196 Quality of Amyotrophic Lateral Sclerosis Care at a Single Veterans Affairs Medical Program

Abstract Introduction Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease marked by progressive motor neuron loss, respiratory failure, and ultimately death. Early signs of respiratory muscle weakness include sleep-disordered breathing, especially nocturnal hypoventilation. Sleep medicine providers can intervene to provide treatment, which can not only improve quality of life but also survival. ALS disproportionately affects Veterans and is designated as a presumptive service-connected condition. However, gaps remain in our understanding of the quality of ALS care delivered within the Veterans Health Administration. This study evaluated the quality of ALS care provided at the VA Pittsburgh Healthcare System (VA) ALS program. Methods This study examined the quality of ALS care provided to Veterans at a single VA ALS program. The American Academy of Neurology ALS Quality Measures were adapted to include additional measures of pulmonary/sleep management. Demographics, travel burden, and rurality data were collected. All Veterans with ALS who attended at least one appointment at the Multidisciplinary ALS Clinic between January 2021 and September 2025 were included. Data were collected through manual chart review. Relevant clinical notes were reviewed to identify any possible barriers or factors influencing adherence to quality measures. Summary statistics were calculated. Results Thirty-one Veterans received care at the Multidisciplinary ALS Clinic. All Veterans were male. 87.1% were White. 9.7% lived in a rural Rural-Urban Commuting Area code. 32.3% of the Veterans had at least one visit through telemedicine. 90.3% of the Veterans received a disease modifying treatment. All Veterans were seen by neurology, speech-language pathology, pulmonary/sleep medicine, and palliative care. 26.7% of the Veterans had a percutaneous endoscopic gastrostomy tube. 77.4% of the Veterans were prescribed a suction machine. 64.5% of the Veterans were prescribed a non-invasive ventilator. 80.6% of the Veterans were prescribed a mechanical insufflation-exsufflation device (i.e. “Cough Assist”). No Veterans used invasive ventilation. Conclusion Overall, Veterans received care aligned with the American Academy of Neurology Quality Measures. Most Veterans received all recommended respiratory support devices. Expanded use of telemedicine may further reduce travel burden for Veterans. Support (if any) Catherine Tarantine is supported by the ATS ASPIRE Fellowship.