Abstract Background Guideline adherence is one of the cornerstones for delivering evidence-based care in inflammatory bowel disease (IBD), yet real-world practice often deviates from guideline recommendations. Understanding the underlying causes of this variability is essential to improve care quality and patient outcomes. Aim: To explore how IBD care is organized and delivered in Dutch hospitals, and to identify context-driven deviations from guidelines using the Functional Resonance Analysis Method (FRAM). Methods Semi-structured interviews were conducted with 14 healthcare professionals (9 gastroenterologists, 5 specialized IBD nurses) from 11 hospitals across the Netherlands. Interviews transcripts and survey responses were analysed using thematic coding. Two FRAM models were developed: a Work-As-Imagined (WAI) model based on national guidelines, and a Work-As-Done (WAD) model based on real-life clinical practice. Results The WAD model revealed non-linear, adaptive care processes, often justified by shared decision-making, resource limitations, and institutional context. Key themes of variability included disease assessment (limited use of formal activity indices), treatment goal setting (ranging from symptom control to mucosal healing), medication strategies (diverse approaches to biologic sequencing and tapering), monitoring practices (variation in use of therapeutic drug monitoring and follow-up intervals), and communication (inconsistent use of digital tools and multidisciplinary team input). Deviations were largely context-sensitive adaptations rather than non-compliance. Conclusion FRAM analysis illustrates that guideline deviations in Dutch IBD care often reflect deliberate, patient-centered adaptations rather than negligence. Future quality improvement initiatives should account for local context and system constraints rather than relying solely on prescriptive guideline adherence. References: 1. Mikocka-Walus A. How can we improve models of care in inflammatory bowel disease? An international survey of IBD health professionals. Journal of Crohn’s and Colitis. 2014;8(12):1668–74. 2. Weaver KN. Variation in Care of Inflammatory Bowel Diseases Patients in Crohn’s and Colitis Foundation of America Partners: Role of Gastroenterologist Practice Setting in Disease Outcomes and Quality Process Measures. Inflamm Bowel Dis. 2016;22:2672-7. 3. Fiorino G. Quality of Care Standards in Inflammatory Bowel Diseases: a European Crohn’s and Colitis Organisation ECCO Position Paper. Journal of Crohn’s and Colitis,. 2020:1037-48. 4. Jackson BD. Clinicians’ adherence to international guidelines in the clinical care of adults with inflammatory bowel disease. inflammatory bowel disease, Scandinavian Journal of Gastroenterology. 2017;52(5):536-42. 5. Lugtenberg M. Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Qual Saf Health Care. 2009;18:385-92. 6. Panés J. Improving quality of care in inflammatory bowel disease: What changes can be made today? J Crohns Colitis. 2014;8:919-26. Conflict of interest: Ms. Van de Koppel, Ilse: part time employee of Maastricht University and Johnson & Johnson innovative medicine. Mujagic, Zlatan: reports grants from ZonMw, Niels Stensen Fellowship, Maag Lever Darm Stichting (MLDS), Academische Alliantie Fonds (AAF), Top consortium for Knowledge and Innovation (TKI), and Galapagos advisory board fees from Johnson & Johnson, Eli Lilly, and Pfizer (paid to host institution) and speaker’s fees from Friso-Friesland Campina, Galapagos/Alfasigma, Celltrion, Eli Lilly, and Takeda (paid to host institution) Duijvestein, Marjolijn: Grant: Speaking fees from Bristol Meyers Squibb, Takeda, Galapagos, Janssen, Dr. Falk, Advisory board fees from Abbvie, Bristol Meyers Squibb, Celltrion, Galapagos/Alfasigma, Janssen, Takeda Grant/Research support: Pfizer, Bristol Meyers Squibb, Galapagos, Alfasigma, Janssen, Lilly Cloots, Manon: N/A klein, Dorthe: No conflict of interest De Bruijn, Daisy: No conflict of interest Joore, Manuela: No conflict of interest Pierik, Marieke: Grant: TKI, MLDS, Galapagos, Janssen-Cilag, Takeda, Pfizer Other: Financial support to institution for consultancy or lectures: Takeda, Janssen-Cilag, BMS, MSD, Abbvie, Galapagos, Ferring
Koppel et al. (Thu,) studied this question.