Measuring the difference we make: the state-of-play of outcomes measurement in the community sector in Western Australia

The term ‘outcomes measurement’ refers to the measurement of the difference that an initiative, program or organisation makes to the lives of people they engage with. Outcomes measurement provides evidence on whether initiatives, programs and organisations are making a difference to the lives of people they serve. It is an important basis of learning within organisations of what works and what doesn’t work. Outcomes measurement also provides the foundation stone for evaluation, strategic planning and good governance, and is critical to good decision-making in respect of the appropriate allocation of resources by funders.  This report extends our previous Bankwest Foundation research and investigates the experiences of on-the-ground community organisations, government and philanthropic funders of community service organisations, and community sector peak bodies with outcomes measurement in Western Australia. This is particularly important in Western Australia as recent regulatory reform has placed outcomes measurement firmly on the agenda for all Western Australia departments, agencies and the organisations they work with.  This study finds outcomes measurement at a tipping point in Western Australia. Our mapping of outcomes measurement in Western Australia and consultations with community sector stakeholders in Western Australia suggest not simply a growing interest in outcomes measurement and a broad appetite for progress and change, but that community sector organisations, big and small, as well as funders, are implementing or seeking to implement a systematic, well-grounded outcomes measurement framework in their organisations and through their funding programs. Community organisations and the funders of programs are also moving towards more strategic use of the outputs of outcomes measurement and connecting measurement with strategy and performance improvement.&nbsp

Explaining Inequality Between Countries: The Declining Role of Political Institutions

Within the fundamental determinants of cross-country income inequality, ‘humanly devised’ political institutions represent a hallmark factor that societies can influence, as opposed to, for example, geography. Focusing on the portion of inequality explainable by differences in political institutions, we decompose annual cross-country Gini coefficients for 95 countries (representing 85 percent of the world population) from 1960-2012. Since 1988, inequality has marginally decreased (from a Gini of 0.525 to 0.521) but the portion that cannot be explained by political institutions has increased substantially (from 0.411 to 0.459). Specifically, the explanatory power of institutions fell rapidly from the late 1980s to the early 1990s. This result prevails when using alternative variables, expanding the sample, weighting countries by population size, and controlling for the remaining fundamental determinants of income: culture and education. Over the same timeframe, the explanatory power of geographical conditions has been rising. This phenomenon appears to be global and is unlikely to be driven by contemporary regional events alone, such as the fall of the Soviet Union, Asian success stories (e.g., China), or institutional monocropping in Africa. A corollary of our finding implies that, if we hold societies responsible for their political institutions, inequality has become notably less fair since the late 1980s

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The Fundamental Determinants of Economic Inequality in Average Income Across Countries: The Declining Role of Political Institutions

Within the fundamental determinants of cross-country income inequality, political institutions represent a hallmark factor that societies can influence. Focusing on the portion of inequality explainable by differences in political institutions, we decompose annual cross-country Gini coefficients from 1960–2012. Although inequality has marginally decreased since 1988, the portion that cannot be explained by political institutions has increased markedly, with the explanatory power of institutions falling rapidly from the late 1980s to the early 1990s. This result prevails when using alternative variables, weightings, samples, and controls, and appears to be unlikely to be driven by contemporary regional events alone. However, we find that the link between institutions and income levels has become increasingly nonlinear as countries with the most inclusive political institutions enjoy even higher incomes than before. Our results imply that, if we hold societies responsible for their political institutions, cross-country inequality has become notably less fair since the late 1980s

An Australian Consensus on Infant Feeding Guidelines to Prevent Food Allergy:Outcomes From the Australian Infant Feeding Summit

Infant feeding in the first postnatal year of life has an important role in an infant's risk of developing food allergy. Consumer infant feeding advice is diverse and lacks consistency.The Australian Infant Feeding Summit was held with the aim of achieving national consensus on the wording of guidelines for infant feeding and allergy prevention.Two meetings were hosted by the Centre for Food and Allergy Research, the Australasian Society of Clinical Immunology and Allergy, and the Australian National Allergy Strategy. The first meeting of 30 allergy researchers, clinicians, and consumers assessed the evidence. The second consensus meeting involved 46 expert stakeholders including state and federal health care agencies, consumers, and experts in allergy, infant feeding, and population health.Partner stakeholders agreed on consensus wording for infant feeding advice: CONCLUSIONS: Consensus was achieved in a context in which there is a high prevalence of food allergy. Guidelines for other countries are being updated. Provision of consistent wording related to infant feeding to reduce food allergy risk will ensure clear consumer advice

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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