A patchwork quilt is a quilt in which the top layer consists of pieces of fabric sewn together to form a design. The quilting design does not necessarily follow the patchwork design, and the design of the quilting may play off the patchwork design.

Originally, this was to make full use of left-over scraps of fabric, but now fabric is often bought specially for a specific design. Fabrics are now often sold in quarter meters (or "yards" in the U.S.). (A "fat quarter" is one square meter folded into four and cut along the folds, thus giving a square piece of fabric 50 cm on a side, as opposed to buying a quarter of a meter off the roll, resulting in a long thin piece that is only 25 cm wide).

Designs can be geometric and formal or imaginative. Patchwork blocks were initially created individually, accumulated over time, by use of scrap and salvaged material. Geometric designs were the most efficient way to aggregate fabric into useful units. Applique, where a piece of fabric is layered on top of the a base or "ground" fabric and then the cut edges are folded under and sewn down, is not limited to simple geometric designs. Early uses of applique in the United States included efforts to expand the effect of expensive, imported European fabrics in early America. The dense printed patterns were cut out, spread apart on a background of plain fabric, allowing the effect of the rare fabric to spread further. Broderie perse is a related techique, were selections of printed fabric are cut out, and sewn in place to produce the effect of a custom printed cloth. Reverse applique involves cutting the ground fabric, and placing another fabric beneath the opening. The raw, cut edges are folded under, and sewn onto the smaller piece of fabric below, creating a new design.

The quilt is formed of three layers: the patchwork, a layer of insulation wadding (batting) and a layer of backing material. These three layers are stitched together ("quilted"), either by hand or machine. The quilting can either outline the patchwork motifs, or be a completely independent design. Additional design options is provided by quilting techniques that alter the texture of the quilt. These include: trapunto (where additional batting is stuffed into a descrete section of the quilting), cording (where cotton cording or yarn are pulled between quilting lines that form channels), and stipple quilting (were dense, closely spaced quilting causes the batting to be more compressed than it is in adjacent areas). Another, more casual option is to "tie" the quilt. Heavy thread or yarn is used to tie all three layers together at points across the surface of the quilt.