{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T05:55:00Z","timestamp":1778046900615,"version":"3.51.4"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMW","doi-asserted-by":"publisher","award":["05160482240003"],"award-info":[{"award-number":["05160482240003"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether the COVID-19 pandemic influenced treatment modality, care intensity, and care setting in benign gynecological care in the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective longitudinal cohort study evaluating the effects of the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nationwide healthcare delivery was analyzed across four benign gynecological pathways from 2017 to 2022 using Vektis and Dutch Hospital Data (DHD), accessed via Statistics Netherlands (CBS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study focused on four benign gynecological pathways, classified using Dutch Diagnosis Treatment Combinations (DTCs): menstrual disorders (G11), uterine fibroids (G15), prolapse (G25), and first-trimester pregnancy complications (Z12). All patients with a new DTC in the first half of each year were included. Exclusion criteria were patients under 18 years, and only in the menstrual disorder pathway, patients over 51 years of age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Intervention or exposure<\/jats:title>\n                    <jats:p>Cohorts from the initial pandemic year (2020) were compared to pre-pandemic years (2017\u20132019), the late pandemic year (2021), and the post-pandemic year (2022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec006\">\n                    <jats:title>Main outcomes and measures<\/jats:title>\n                    <jats:p>The primary outcome was the change in treatment mix within the care pathways. Secondary outcomes included regional variation, hospital-type distribution and care intensity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec007\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2020, all care pathways showed reduced unique patient volumes. Treatment mix did change during the COVID-19 pandemic, but not uniformly across the four pathways toward more less-invasive options. We found no regional differences in treatment mixes. Patient age, number of care activities and medication use remained stable. Telephone follow-up consultations increased markedly in 2020. No deviation from the trend was observed in respect of hospital type providing care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec008\">\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>A sharp reduction in benign gynecological care did not result in strategies to minimize patient harm like prioritization or substitution of care, as observed with our available claims data. Our findings indicate a lack of flexibility in health care provision to adjust to rapidly changing demands. Data limitations underscore the need for complementary research using other data sources to assess patient harm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345619","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:37:31Z","timestamp":1775065051000},"page":"e0345619","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating patient harm minimization during the COVID-19-driven reduction in benign gynecological care: a nationwide claims-based longitudinal study in the Netherlands"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6386-4007","authenticated-orcid":true,"given":"Eva L.M.","family":"Velthuijs","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismail","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"de Leeuw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wouter J.K.","family":"Hehenkamp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xander H.E.","family":"Koolman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"issue":"3","key":"pone.0345619.ref001","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-045343","article-title":"Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review","volume":"11","author":"R Moynihan","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0345619.ref002","volume-title":"Adult elective surgery and procedures recommendations Limit all non-essential planned surgeries and procedures, including dental, until further notice","author":"CMS","year":"2020"},{"issue":"9","key":"pone.0345619.ref003","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1002\/bjs.11646","article-title":"Global guidance for surgical care during the COVID-19 pandemic","volume":"107","author":"COVIDSurg Collaborative","year":"2020","journal-title":"Br J Surg"},{"key":"pone.0345619.ref004","article-title":"Inhaalzorg na corona: hoe staan we ervoor?","author":"H Maassen","year":"2021","journal-title":"Medisch Contact"},{"key":"pone.0345619.ref005","doi-asserted-by":"crossref","first-page":"115658","DOI":"10.1016\/j.socscimed.2023.115658","article-title":"Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands","volume":"320","author":"M Oosterhoff","year":"2023","journal-title":"Soc Sci Med"},{"issue":"2","key":"pone.0345619.ref006","doi-asserted-by":"crossref","first-page":"139","DOI":"10.3233\/HAB-200420","article-title":"Global burden of COVID-19: Situational analyis and review","volume":"29","author":"AA Gebru","year":"2021","journal-title":"Hum Antibodies"},{"issue":"1","key":"pone.0345619.ref007","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13037-022-00331-y","article-title":"Impact of the COVID-19 pandemic on delays in surgical procedures in Germany: a multi-center analysis of an administrative registry of 176,783 patients","volume":"16","author":"R Hunger","year":"2022","journal-title":"Patient Saf Surg"},{"key":"pone.0345619.ref008","unstructured":"Financial Times. 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