REAL WORLD IMPLEMENTATION OF TREAT-TO-TARGET IN PATIENTS WITH IBD IN A LEARNING HEALTH SYSTEM: AN IBD QORUS COLLABORATIVE STUDY

Background and Aims: A treat-to-target (TTT) strategy of striving for symptomatic and endoscopic remission is recommended for the management of inflammatory bowel diseases (IBD). Yet, real-world uptake of TTT strategies has been modest. We sought to assess the feasibility of implementing TTT and improve its uptake in the Crohn’s and Colitis Foundation’s learning health system (LHS), IBD Qorus.

Methods: Through encounter-level provider filled surveys, we examined an ‘intention to TTT’ for each eligible clinic visit (for patients identified as not being in endoscopic remission on most recent endoscopic evaluation) across a multi-center LHS over a 12-month period (November 2020-November 2021). ‘Intention to TTT’ (or TTT score) was defined as an affirmative response to all three of the following: (1) Was treat-to target discussed with patient, (2) Was objective assessment for inflammation (endoscopy, radiology and/or fecal calprotectin) performed within the preceding 12m, (3) Is there an intention to change treatment since target has not been reached. Over a 12-month breakthrough series (BTS) collaborative, we sought to improve implementation of TTT with monthly report cards, webinars, an active listserv and two all-Qorus learning sessions. Changes in rates of ‘intention to TTT’ were examined over 12 months, overall and at each site, with an earliest clinically meaningful signal of improvement defined a priori as 2% increase per month.

Results: Over 12 months, there were 7934 patient visits across 38 sites in the IBD Qorus collaborative; patients in 37% visits (n=2913) were not in endoscopic remission at time of visit. Overall, rates of ‘intention to TTT’ increased from 23% at the beginning of the BTS, to 49% at the end of the BTS, corresponding to a clinically significant 2.4% per month increase in rates of implementing TTT (p<0.01) (Figure 1). While rates of discussion of TTT (88% of eligible visits) and intention to adjust therapy (70% of eligible visits) were consistently high, there was a significant increase in objective evaluation for inflammation during the course of the BTS. There was considerable variability across sites in rates of ‘intention to TTT’ across sites.

Conclusions: Through a quality improvement initiative in a LHS, rates of ‘intention to TTT’ increased significantly over 12-months, though overall rates remained low. Assessing patient-, provider- and practice-level barriers and facilitators for successful implementation of a TTT strategy is warranted to improve clinical outcomes.