Objective: Report on initial choice, modification and accountability of ALS–performance measures in an ALS Clinic at a major medical center affiliated with a state-based medical school. Background AAN–ALS Guidelines(1999) were not formally deployed on a per–clinic basis, but were evaluated in a subset of clinics participating in the ALS CARE Database. A formal analysis between 1999–2004 indicated that guideline adherence increased from 3–31% to 9–43%[Ann Neurol 2009;65 (suppl):S24–S28]. Despite increased adherence to the AAN–ALS Guidelines, there is a 57–91% gap in patient care depending on the specific recommendation. In order to increase adherence to the AAN–ALS Guidelines(2009), we implemented a formal TJC–DSC process to develop per-patient performance measures to allow prospective assessment of guideline adherence according to the TJC–DSC protocol currently in place for heart disease, diabetes and stroke. Design/Methods: ALS–performance measures need to be developed from 80 primary(nearly 200 secondary)recommendations from the AAN–ALS Guidelines(2009). Based on the TJC–DSC protocol, ALS–performance measures identifying 1)cognitive function(Mini-Mental State Examination). 2)depression(Patient Health Questionaire), 3)falls(number of falls since last clinic visit) and 4)dispersal of care plans to MDs(faxed completed encounter reports) were chosen initially by the working group. Results: During the first 6 months, we identified that number of falls was more effective in identifying patients at risk for falls than the Hendrich II Falls Scale. Number of falls became an audit-established measure to be completed at each clinic visit when 5)respiratory management checklist became the new auditable measure. Provider monthly accountability (mean±standard deviation%] improved for all measures between the first and second 6-month intervals: 1)cognition(50±23%; 90±7%), 2)depression(95±6%; 92±8%), 3)falls(98±3%; 98±3%), 4)dispersal of care plan(90±8%; 91±7%), 5)respiratory management(99±1%;initiated in second 6 months). Conclusions: The process of implementation of AAN–ALS Guidelines-specific ALS–performance measures was initiated for 5/80 primary(200 secondary)recommendations. Accountability measures indicate that providers still need training to achieve 100% adherence. Patient acceptance and adherence accountability measures are being developed. Supported by: Carolinas ALS Research Fund, Pinstripes Fund, Muscular Dystrophy Association. Disclosure: Dr. Brooks has received personal compensation for activities with Avanir Pharmaceuticals, Bayer Healthcare Pharmaceuticals, Biogen Idec, Genentech, Inc., and Teva Neuroscience. Dr. Brooks has received research support from Avanir Pharmaceuticals, Biogen Idec, NINDS, Novartis, and Teva Neuroscience. Dr. Williams has nothing to disclose. Dr. Bravver has nothing to disclose. Dr. Desai has nothing to disclose. Dr. Wright has nothing to disclose. Dr. Sanjak has nothing to disclose. Dr. Bockenek has nothing to disclose. Dr. Nichols has nothing to disclose. Ms. Russo has received personal compensation for activities with Serono, TEVA and Biogen as a consultant. Dr. Smith has nothing to disclose. Dr. Blythe has nothing to disclose. Dr. Lindblom has nothing to disclose. Dr. Pacicco has nothing to disclose. Dr. Smrcina has nothing to disclose. Dr. Ward has nothing to disclose. Dr. Langford has nothing to disclose. Dr. Fischer has nothing to disclose. Dr. O9Neill has nothing to disclose. Dr. Henderson has nothing to disclose. Dr. Holsten has nothing to disclose. Dr. Frumkin has nothing to disclose. Dr. Walgren has nothing to disclose. Dr. Corey has nothing to disclose. Dr. Oplinger has nothing to disclose. Dr. Price has nothing to disclose. Dr. Fortier has nothing to disclose.