North Carolina is entering a period of transformative change in health care, as health system consolidation, health care reform, and payment reform combine to dramatically reshape health care. In this turbulent time, maintaining focus on quality of care will be critical. North Carolina has been a national leader in efforts to improve quality of care, starting from classic research in the 1950s on the measurement of quality and culminating in major statewide efforts to improve care through the North Carolina Area Health Education Centers Program, Community Care of North Carolina, the North Carolina Hospital Association, Medicaid, Blue Cross and Blue Shield of North Carolina, academic centers, and many other partners. The purpose of this issue of the NCMJ is to highlight initiatives to improve quality across the continuum of care and across the state. This overview puts these initiatives in context and addresses 3 fundamental questions: Can quality of care be measured and improved? What does the landscape of quality in North Carolina look like now? What should North Carolina's priorities be for improving quality of care moving forward?