This study examines the efforts of higher education systems in six states to implement large-scale changes to improve student outcomes in mathematics in community colleges and four-year colleges and universities as part of the Mathematics Pathways to Completion (MPC) project. The three-year project was launched in 2015 to help Arkansas, Massachusetts, Michigan, Missouri, Oklahoma, and Washington adopt the Dana Center Mathematics Pathways model, largely by facilitating cross-sector and cross-institutional collaboration. The goal was for these states to implement mathematics pathways as a "normative, sustained, and institutionalized practice" for all students in all public postsecondary institutions. This final report of the MPC project describes how the Dana Center's project design supported participating states in navigating challenges related to implementing mathematics pathways statewide and offers examples of how states made progress toward their goals. In this report, the authors describe the Dana Center's theory of scale, which combines "top-down" policy changes that enable reform implementation with "bottom-up" flexibility that allows individual institutions to adapt and develop approaches to fit their context. Drawing on institutional surveys, self-assessments by state leaders, stakeholder interviews, and project documents, this report explores two overarching questions: (1) How did states engage diverse stakeholders across higher education sectors using a top-down/bottom-up approach to implementing mathematics pathways at scale statewide?; and (2) What challenges did states encounter in implementing mathematics pathways statewide, and what successes resulted from their work? The report's findings are organized across three phases of state-level work. [This research was conducted in association with the Charles A. Dana Center at The University of Texas at Austin.]