Real-World Implementation of Treat to Target in Patients With IBD in a Learning Health System: An IBD Qorus
Siddharth Singh1, Brant J Oliver2,3,4,5, Jason K Hou6
1Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259, United States.
Inflammatory Bowel Diseases
|January 7, 2026
Summary
A quality improvement project increased the intention to use treat-to-target (TTT) strategies in gastroenterology practices. However, this did not significantly improve patient remission rates, highlighting the need to address implementation barriers.
Area of Science:
- Gastroenterology
- Quality Improvement Science
- Learning Health Systems
Background:
- Real-world utilization of treat-to-target (TTT) strategies in inflammatory bowel disease (IBD) care requires examination.
- A quality improvement (QI) project was initiated to enhance TTT strategy adoption within the IBD Qorus learning health system.
Purpose of the Study:
- To implement a structured QI intervention aimed at increasing the uptake of TTT strategies across multiple gastroenterology practices.
- To assess the impact of improved intention to TTT on site-level achievement of remission in IBD patients.
Main Methods:
- A modified breakthrough series (BTS) collaborative QI intervention was applied across 41 US gastroenterology practices over 13 months.
- Encounter-level surveys captured provider "intention to TTT," including discussion, inflammation documentation, and therapy change intent.
- Changes in "intention to TTT" rates and their correlation with remission rates were analyzed during intervention and post-intervention periods.
Main Results:
- Over 7932 patient visits, intention to TTT increased from 31% to 54% (P=.06), attributed to enhanced inflammation testing.
- This increase was largely maintained post-intervention (49%), but with significant site-to-site variability.
- Despite the rise in intention to TTT, no significant improvement in site-level patient remission rates was observed.
Conclusions:
- A QI initiative successfully boosted the intention to implement TTT strategies in IBD care over 12 months, though overall adoption remained suboptimal.
- Further research into patient, provider, and practice-level barriers and facilitators is crucial for effective TTT strategy implementation and improved clinical outcomes.
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