​On October 11, 2013, the Public Health Foundation (PHF) convened the second meeting of its Antibiotic Stewardship Advisory Group to discuss current and future activities using the Public Health Antibiotic Stewardship Driver Diagram. During this meeting, the three public health pilot sites participating in the Antibiotic Stewardship Program shared their strategies for effectively collaborating with healthcare partners to address a community health issue. The group also discussed the far-reaching potential for public health to use driver diagrams and similar approaches in collaboration with healthcare to address a wide range of community health challenges. The Antibiotic Stewardship Advisory Group includes thought leaders from federal agencies, national partner organizations, representatives from the three current pilot sites, and other subject matter experts.

• The Connecticut Department of Public Health used QI tools to create strategies for tracking and treating antibiotic resistant infections at long-term care facilities, and improving clinical practice to reduce the spread of infection. Read more here.
• The Independence Health Department (Independence, Missouri) built on existing relationships with Centerpoint Medical Center (an IHI pilot site) and area childcare facilities to improve the prescribing habits of physicians and educate parents about optimal antibiotic use for children in daycare. Read the full story here.
• The Maine Centers for Disease Control and Prevention used QI tools to identify facilities—and pockets within facilities—with the highest rates of the antimicrobial resistant Clostridium difficile infection, and through collaboration with healthcare partners, took steps to improve preventive measures in the targeted areas. Read more here​.

While each pilot site approached the challenge differently, together these pilot efforts addressed all of the primary drivers of optimal antibiotic use noted on the Public Health Antibiotic Stewardship Driver Diagram. Several factors emerged as critical to the success of these efforts: 

• Use of the Public Health Antibiotic Stewardship Driver Diagram – A driver diagram illustrates primary and secondary drivers of a health challenge; each organization chose drivers to address in pilot activities.
• Use of QI tools and methods – All three pilot sites used QI tools and methods, particularly with regard to ensuring improvements were effectively adopted.
• Collaboration Between Public Health and Healthcare – Collaboration enabled each health department to function as a resource to its healthcare partners; this included helping partners meet regulatory requirements and address fiscal needs, convening and facilitating productive discussions, and communicating broadly about their joint activities.