Treat-to-Target Strategy Uptake Improves but Remains Low in US IBD Care
Adoption of treat-to-target strategies in inflammatory bowel disease (IBD) improved following a structured quality improvement (QI) initiative within a US learning health system, according to a study in Inflammatory Bowel Diseases. Despite statistically significant gains over 12 months, overall uptake remained low, underscoring ongoing challenges in translating guideline-recommended care into routine clinical practice.
Study Findings: QI Initiative Boosts but Does Not Normalize Treat-To-Target Use
Investigators evaluated implementation of treat-to-target within IBD Qorus, a national learning health system aimed at improving IBD care delivery across the United States. Treat-to-target focuses on achieving predefined clinical, biomarker, and endoscopic targets rather than relying solely on symptom control.
Following a 12-month QI intervention, rates of documented intent to use treat-to-target increased significantly across participating sites. The initiative incorporated standardized workflows, performance feedback, and collaborative learning strategies to encourage adherence to evidence-based targets.
The study emphasized that multilevel barriers—including provider practice patterns, system constraints, and patient-related factors—continue to limit broader adoption. These findings highlight a persistent gap between guideline recommendations and real-world IBD management.
Clinical Implications: Addressing Barriers to Guideline-Concordant IBD Care
Treat-to-target strategies have been associated with improved long-term outcomes in IBD, including higher rates of mucosal healing, fewer hospitalizations, and reduced disease complications. Yet, this study demonstrates that implementation in everyday practice remains inconsistent.
For clinicians, the findings reinforce the importance of incorporating objective disease monitoring—such as fecal calprotectin, C-reactive protein, and endoscopy—into longitudinal care. Standardized care pathways and electronic health record–based decision support may help operationalize treat-to-target principles.
At the system level, participation in learning health networks like IBD Qorus may facilitate benchmarking and dissemination of best practices. However, overcoming barriers will likely require targeted interventions addressing workflow efficiency, resource allocation, and provider education.
Improving adoption of treat to target could enhance care standardization and optimize outcomes for patients with Crohn’s disease and ulcerative colitis.
While QI-driven efforts can improve uptake of treat-to-target strategies in US IBD care, overall use remains limited. Future initiatives should focus on scalable solutions to overcome persistent implementation barriers and align real-world practice with established treatment targets.
Reference
Singh S, Oliver BJ, Hou JK, et al. Real-world implementation of treat to target in patients with IBD in a learning health system: an IBD Qorus collaborative study. Inflamm Bowel Dis. 2026;32(4):702-710. doi:10.1093/ibd/izaf287
