Between 2012 and 2016, the OECD conducted a series of in-depth reviews of the policies and institutions that underpin the measurement and improvement of health care quality in 15 different health care systems (Australia, Czech Republic, Denmark, England, Israel, Italy, Japan, Korea, Northern Ireland, Norway, Portugal, Scotland, Sweden, Turkey and Wales). The 15 settings examined are highly diverse, encompassing the high-tech, hospital-centric systems of Japan and Korea, the community-focussed Nordic systems, the unique challenges of Australia’s remote outback, and the historically underfunded systems of Turkey and the Czech Republic, now undergoing rapid modernisation. What unites these and all other OECD health care systems, however, is that all increasingly care about quality. In a time of multiple, unprecedented pressures on health care systems – many of which are beyond health care systems’ control – central and local governments as well as professional and patient groups are renewing their focus on one issue that they can control and one priority that they equally share: health care quality and outcomes. In the OECD’s work to measure and improve health care system performance, health care quality is understood to comprise three dimensions: effectiveness, safety and patientcentredness (or responsiveness). These dimensions are applied across the key stages of the care pathway: staying well (preventive care), getting better (acute care), living with illness or disability (chronic care) and care at the end of life (palliative care). This conceptual framework is illustrated in Figure 0.1.

This volume has many points of origin. Various chapters in this volume will have their own narratives with a beginning and perhaps an end. This introduction will lay groundwork for the following chapters. On my part, I will start for now with the American Psychiatric Association meeting in San Francisco in 2013. A symposium there was titled, “Bringing the Uniform out of the Closet: Artistic and Clinical Perspectives of Gay Military Life Before and After ‘Don’t Ask, Don’t Tell’” . I was asked to speak because of my role participating in the Pentagon work group to examine the repeal of “Don’t Ask, Don’t Tell” (DADT). That work group was convened in 2010 to examine how and if to repeal the DADT policy. There my main contribution was pushing the DoD group to move past discussion of fears of battlefeld transmission of HIV, to the positive effects of service members not having to live in fear of exposure of their sexual identity.

A CVA is a very serious and sudden occurrence. This is thus a specifc symptom of this CNS disorder, in contrast to dementia, Parkinson’s, and MS, which are characterized by their progressive course. Over the last few decades, the care for CVA patients has improved enormously, and much expertise has been gained in terms of insights into the impairments that result from a CVA. The experience thus gained can be transposed to the other CNS disorders described in this book. There are, namely, many commonalities, and this provides the opportunity to place neurorehabilitation in a broader perspective. This chapter lists the symptoms that may be an indicator for the occurrence of a CVA, which is followed by the description of the symptomatology after a cerebrovascular accident (CVA). Given that patients are permitted direct access to physiotherapy in the Netherlands, the physiotherapist must be able to recognize symptoms at an early stage. This chapter also examines the causes and risk factors of a CVA. When these are recognized, it is possible to take specifc actions that reduce the chance of a CVA.