IntroductionThe lack of understanding of how complex integrated care programmes achieve their outcomes due to the lack of acceptable methods leads to difficulties in the development, implementation, adaptation and scaling up of similar interventions. In this study, we evaluate an integrated care network, the National University Health System (NUHS) Regional Health System (RHS), consisting of acute hospitals, step down care, primary care providers, social services and community partners using a theory-driven realist evaluation approach. This study aims to examine how and for whom the NUHS-RHS works to improve healthcare utilisations, outcomes, care experiences and reduce healthcare costs. By using a realist approach that balances the needs of context-specific evaluation with international comparability, this study carries the potential to address current research gaps.Methods and analysisThis evaluation will be conducted in three research phases: (1) development of initial programme theory (IPT) underlying the NUHS-RHS; (2) testing of programme theory using empirical data; and (3) refinement of IPT. IPT was elicited and developed through reviews of programme documents, informal discussions and in-depth interviews with relevant stakeholders. Then, a convergent parallel mixed method study will be conducted to assess context (C), mechanisms (M) and outcomes (O) to test the IPT. Findings will then be analysed according to the realist evaluation formula of CMO in which findings on the context, mechanisms will be used to explain the outcomes. Finally, based on findings gathered, IPT will be refined to highlight how to improve the NUHS-RHS by detailing what works (outcome), as well as how (mechanisms) and under what conditions (context).Ethics and disseminationThe National Healthcare Group, Singapore, Domain Specific Review Board reviewed and approved this study protocol. Study results will be published in international peer-reviewed journals and presented at conferences and internally to NUHS-RHS and Ministry of Health, Singapore.

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Objectives: Singapore's healthcare landscape comprises public and private sector providers. Care in public sector institutions is heavily subsidised. The public polyclinics, comprising 14% of our primary care doctors, manage 45% of the country's chronic disease load in primary care. This disproportionate distribution resulted in an under-utilisation of our private physician resource and strained the public sector. An innovative public-private partnership model was conceived to establish new Family Medicine Clinics (FMC). This may lead to better optimisation of healthcare resources, and lower overall healthcare costs. Methodology:The model involves a multi-disciplinary team led by private Family Physicians in a group practice setting. We will discuss the planning considerations to establish the country's first FMC, the value propositions and how it aimed to address some of the gaps in the healthcare delivery system. Challenges and preliminary observations will be shared.Results: Extensive physician and patient engagement was conducted to promote this new model of care, resulting in increased referrals from the hospital's specialist outpatient clinics. Continuity of care was established through shared medical records and close physician interaction between the hospital and FMC.Conclusions: Preliminary observations demonstrated a potential for this model to be replicated to strengthen healthcare delivery in Singapore and reduce fragmentation of care.