Studies have shown that disagreement between patients and clinicians on the patient’s progress leads doctors to neglect key issues and symptoms, resulting in diminished patient satisfaction. Patient perspectives in outcome assessments, suggesting the addition of functional priority questions in regular evaluations with the aim of improving care and health status in RA, was first introduced in 2002 at the sixth annual conference for Outcomes Measures in Rheumatology Clinical Trials (OMERACT). There is, however, little research on the most effective way to incorporate patient-centered evaluation into regular office practice. PACO, a BWH-directed initiative, has been designed to address this issue and to determine how best to implement the patient-centered methodology. For this project, the Foundation is providing a grant of $1,032,954 over four years.

The AF has identified timely diagnosis and treatment of persons with early RA as a key area of concern that limits the dissemination of proven therapies to this population, thus hampering RA disease control efforts. Reducing the referral times by days, weeks, or months has the potential to significantly reduce the impact of RA on the individual. A simple screening tool and education program about the importance of early diagnosis and treatment for primary care physicians is needed to facilitate the detection of early onset inflammatory arthritis. The screening tool -- similar to those assessing risk for coronary artery disease that consist of patient symptoms, physical findings, and simple laboratory tests and x-rays -- would identify those who are most likely to have inflammatory arthritis and who would benefit from a referral to an arthritis specialist to be evaluated for early treatment. In addition, this screening tool will allow rheumatologists to set aside time to see those people with probable RA who need prompt evaluation. Currently the waiting time for a rheumatologist is over three months in some areas of the United States. This screening tool will assist the primary care and rheumatology communities to offer timely new patient visits to people with probable RA.

The screening tool will be developed by drawing on the scientific leadership in rheumatology of the AF and ACR and the expertise in women's health of the National Women's Health Resource Center and other experts. It will be implemented in 2-3 pilot sites, evaluated and optimized for dissemination through a physician education program. For this project, the Foundation is providing a $400,000 grant.

Since 1999, the Foundation has provided $800,000 in grants to the National Women's Law Center to produce four National and State-by-State Report Cards on women’s health policies and services, formally titled "Making the Grade for Women’s Health" (1999, 2001, 2004, 2007). These report cards serve as invaluable tools for state policy makers because they focus on women’s health priorities in their states and capture progress made within the election cycle.

Foundation funding has also allowed the NWLC to produce interim reports focused on specific issues such as heart disease. In 2003, NWLC, in partnership with Oregon Health and Science University, published an interim report card on Women and Smoking, providing a wake-up call for governments at all levels to do more to reduce tobacco use among women and girls throughout the U.S. After all, smoking is the leading cause of preventable death in the U.S., killing more than 178,000 women each year. It is the primary cause of lung cancer, the leading cancer killer of women, and a major risk factor for cardiovascular disease. Yet, smoking rates among women and girls remain high—more than one in five adult women in the U.S. smoke—and smoking cessation treatments are not accessible to many women. This report focused on how well the country as a whole and individual states were doing in meeting relevant benchmarks to reduce smoking among women to a national goal of 12 percent. Thus far, most states as well as the country overall have received failing grades.

2004-2005: Focus on cardiovascular disease

Cardiovascular disease is the number one killer of women, claiming the lives over 500,000 women each year -- more than all types of cancers combined. It has been the leading cause of death among women for over 100 years. And -- a much lesser known statistic -- cardiovascular disease kills 65,000 more women than men each year. What is significant about these statistics, beyond recognition of the stunning mortality rates from a preventable disease, is that the general public as well as legislators and health officials are largely unaware of these facts. Women tend to perceive breast cancer as a much larger threat, but in fact, women are 10 times more likely to die of heart disease than breast cancer. For over 60% of women suffering from cardiovascular disease, their first symptom will be death.

What this translates into is a serious crisis in state medical policies which, when addressed, will save lives and prevent overspending on late-diagnosis interventions. The Foundation has formed a partnership with Women in Government to conduct the first ever summits of state-level Offices of Women’s Health (OWH). With the support of a two year grant of $282,000, WiG was to establish and convene a meeting of the administrative leaders of OWHs and their legislator champions to support their efforts to tap existing resources for the prevention and treatment of heart disease in women and to support the development of legislative strategies and concrete plans of action to reduce cardiovascular disease in women. The first summit was held in March 2004 and the second was held in March 2005.

2006: Focus on women and substance abuse

Substance abuse in women and girls is routinely listed in WIG member surveys as a priority for state legislators. Recognized in Women Under the Influence by another Bristol-Myers Squibb Foundation grantee, the National Center for Addiction and Substance Abuse at Columbia University, the problems women face with addiction are unique and more severe than their male counterparts. According to studies by the National Institute on Drug Abuse, perceived risk associated with substance abuse has worked as an effective deterrent for young women in recent years. This means that early education and prevention efforts are imperative in curbing substance abuse and addiction in girls and women.

Gender specific substance abuse education is critical for state legislators, state offices of women’s health, and state addiction and/or mental health offices. Through Women In Government’s partnership with the Bristol-Myers Squibb Foundation, the 2006 summit, held March 29-April 1, sought to help overcome barriers and forge communication among state offices of women’s health, offices of addiction services and legislators in order to establish new action plans, partnerships and support systems for addressing this issue at the state level. The Foundation made a grant of $175,000 to support the summit.