Saudi Arabia's Hospital Clustering and Patient-Centered Care: A Mixed Methods Evaluation of Chronic Disease Management under the Saudi Health Sector Transformation Program

Background: The Health Sector Transformation Program is a key part of Saudi Arabia’s Vision 2030. One of its main goals is to improve patient centered care through hospital clustering. However, limited evidence exists on how clustered and non-clustered hospitals differ in managing chronic diseases. Objective: To assess patient centered care in chronic disease management in clustered and non-clustered hospitals in Saudi Arabia. Methods: A mixed methods study was conducted in four hospitals in Mecca and the Eastern Province between 2016 and 2024. Two hospitals were clustered and two were not. Quantitative data were taken from hospital records to assess patient centered care indicators, digital health use and resource utilization. Qualitative data were collected through 53 in depth interviews with patients and physicians to explore care experiences and implementation challenges. Results: Clustered hospitals had higher patient centered care index scores than non-clustered hospitals (99.06 vs. 89.82, p<0.001). Patient satisfaction was higher (87.6 vs. 79.7, p<0.001) and readmission rates were lower (8.5 vs. 14.5%). Digital health adoption was greater in clustered hospitals (72.5 vs. 45.0, p = 0.02). Interview findings supported these results and showed better care coordination and accountability in clustered hospitals. Non clustered hospitals reported limited resources and uneven care processes. Conclusions: Hospital clustering under the Health Sector Transformation Program is associated with better patient centered care and improved chronic disease outcomes. Ongoing gaps in non-clustered hospitals highlight the need for focused investment in digital systems and workforce training to support equitable progress under Vision 2030.