Accomplishments of the pilot sites included further adoption of best practices, expanded partnerships and the commitment to continue them, and education on appropriate antibiotic use for physicians, pharmacists, and nurses. The three sites were:

• Connecticut Department of Public Health used improvement 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.
• Independence Health Department (MO) 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.
• Maine Center for Disease Control and Prevention used improvement 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.

Their stories point to several factors that have been critical to the success of their collaboration:

• Use of the Public Health Antibiotic Stewardship Driver Diagram. A driver diagram illustrates primary and secondary drivers of a health challenge; each pilot site used the driver diagram as a reference for selecting points of intervention.
• Use of Quality Improvement Tools and Methods. The work of all three pilots incorporated QI to ensure that improvement strategies were effectively targeted and adopted.
• Collaboration Between Public Health and Healthcare. Each health department functioned as a resource to its healthcare partners, helping them to meet regulatory requirements and address fiscal needs, convening and facilitating productive discussions, and communicating about joint activities.