ECOG performance scale is one of the tools used to assess the functional status. However, there is no consistency in using this tool and documenting the patient’s performance score among nurses and physicians at USC-Norris Cancer Center. This quality initiative came to life to make sure every single cancer patient is having ECOG assessment prior to and after his/her treatment, and to address any discrepancies between nurses and physicians’ ECOG assessment and documentation.


Due to the prevalence of treatment-related alterations in oncology/hematology patients’ functional capacity following therapies, regular assessments of functional and performance status using the Eastern Cooperative Oncology Group (ECOG) performance scale was implemented at USC-Norris ambulatory services and offsite infusion centers and clinics. The aims of increasing the compliance of physicians and nurses ECOG documentation are: Assessing how the disease impacts the cancer patient’s daily living abilities; Determining how the patient tolerates the treatment; Determining the appropriate treatment plan and prognosis; and Forming goals of care.


On each clinical encounter or treatment day, the nurse performs and document patient’s performance status assessment. Physician documentation is required for ECOG score of “4”. To identify the right patient population, the patient should have ICD-10 code for neoplasm and encounter for antineoplastic chemotherapy or immunotherapy. Data abstraction team with the help of coding team isolated the ICD-10 codes and determined the chemotherapy and immunotherapy encounter codes.


Baseline data was collected in June 2021 and showed ECOG documentation compliance rate of 56.9% out of 2744 eligible encounters. After implementing the training in July 2022 on how to use the performance assessment tool in Cerner, the compliance rate increased to 61.4% out of 2513 cases in July and trended up to 75% out of 2079 in December. Currently, we are maintaining an ECOG score documentation above 80% for 4 months in a raw from Jul-Oct 2022.