Health services research in a quick and dirty world: the New York City hospital occupancy crisis.

In 1987/1988, New York City experienced an unexpected health care crisis: a severe and prolonged communitywide shortage of inpatient hospital beds. A rapid rise in hospital occupancy rates dramatically ended a long-term decline in hospital utilization and left health care providers and policymakers baffled about both cause and remedy. This article describes the course of a short-term, intensive, midcrisis study that unraveled the reasons for the high occupancy rates. As a case study for a research effort that successfully yielded valid and timely results, this article illuminates the research design and methodological decisions that lay behind the findings and discusses the implications of those decisions. Key to the success of the study were a mandate to diagnose the crisis, a statewide patient discharge data base, our previous hands-on experience with that data base, active support for the study from the community of health care providers, and strong results.