Acute Hospital-at-Home Care for Selected Older People in Viet Nam: Defining Safe Eligibility, Clinical Accountability and Escalation Pathways

INTEGRATED CARE & CARE TRANSITIONS · AGE-FRIENDLY CARE QUALITY

Last reviewed: October 2026

An older patient arrives at a hospital in Viet Nam with an acute illness. Following examination, diagnostic testing and initial treatment, the clinical team determines that hospital admission is necessary. The patient's condition is not immediately life-threatening, but active treatment, repeated assessment and access to further investigations are still required. Under conventional arrangements, the next step would be admission to an inpatient ward.

There may be another option. If an appropriately organized clinical team can deliver the required treatment at home, monitor the patient's condition and arrange prompt hospital transfer when necessary, an acute inpatient admission might be avoided. For some older people, receiving treatment in familiar surroundings may be preferable to spending several days in a hospital ward.

But this decision cannot rest on patient preference or hospital bed availability alone. Another patient with similar symptoms may have unstable vital signs, increasing oxygen requirements or a condition that could deteriorate rapidly. For that person, remaining at home could delay treatment that is only safely available in a hospital.

This distinction is fundamental to hospital-at-home care. The question is not whether home is generally a better place for older people to receive treatment. It is whether a particular patient, with a particular acute illness, can safely receive the necessary level of care through a clinical service designed and authorized to provide it.

Internationally, hospital-at-home programs have developed along different pathways. Some provide hospital-level treatment at home instead of an acute inpatient admission. Others allow patients to leave the hospital earlier while continuing hospital-level treatment at home. Although both may be described as hospital-at-home, they involve different clinical decisions, service requirements and evaluation measures.

This article focuses specifically on admission-avoidance hospital-at-home: a time-limited model of active acute treatment for selected patients who would otherwise require hospital admission.

It does not address routine home nursing, ordinary chronic disease management, rehabilitation after acute treatment or early-discharge hospital-at-home programs. Its focus is the decision to replace a necessary acute hospital admission with a clinically accountable episode of treatment at home.

For Viet Nam, where clinical resources, emergency response capacity and home environments vary considerably, the challenge is to determine when this alternative is genuinely safe, legally appropriate and operationally feasible.

Hospital-at-Home Is Defined by Clinical Capability, Not by Location

A medical service does not become hospital-at-home simply because a physician or nurse visits someone at home. Adding video consultations, wearable devices or remote monitoring does not automatically turn an ordinary home care service into an alternative to acute hospitalization.

Admission-avoidance hospital-at-home begins with a professional determination that the patient requires acute treatment that would otherwise justify inpatient admission. The proposed alternative must then be capable of delivering the necessary treatment, clinical assessment, diagnostic support and timely response throughout that episode.

Many older people benefit from home-based healthcare without needing hospital-level treatment. Someone with a stable chronic condition may receive appropriate outpatient follow-up. A person recovering from an illness may need rehabilitation or assistance with daily activities. These services have different purposes and should not automatically be grouped under the hospital-at-home label.

In admission avoidance, the patient receives an organized episode of acute care under identifiable clinical responsibility. The treatment location changes, but the need for appropriate professional oversight remains.

Patients may be assessed in an emergency department, an acute medical assessment unit or another clinically appropriate setting before entering the program. Some international services also accept referrals from community clinicians when reliable assessment and decision-making arrangements are available.

Admission avoidance therefore does not necessarily mean that the patient never enters a hospital building. It means that the planned acute inpatient admission is replaced by a suitable episode of hospital-level care at home.

The model also has practical limits. Hospital-at-home is not intended to reproduce every capability of an acute hospital inside a private residence. Its value depends on identifying patients whose treatment needs can be met safely through a defined combination of home-based clinical services and accessible hospital support.

What the International Evidence Supports

The evidence for admission-avoidance hospital-at-home is encouraging, particularly for appropriately selected older patients. However, the findings are more specific than some broad claims about treating acute illness at home suggest.

The Cochrane review Admission Avoidance Hospital at Home, updated by Edgar and colleagues in March 2024, included 20 randomized controlled trials involving 3,100 participants with a range of acute conditions. The review examined active treatment delivered at home instead of conventional hospital admission. Although published in 2024, its formal literature search was conducted in February 2022.

For older patients, the review found that admission-avoidance hospital-at-home probably makes little or no difference to mortality at six months compared with inpatient care. The pooled relative risk was 0.88, with a 95% confidence interval of 0.68 to 1.13.

The review also found little or no difference in subsequent hospital admission during follow-up. Patients receiving hospital-at-home were less likely to be living in residential care at six months, although the findings varied across studies.

Patient satisfaction may be higher with care at home, but confidence in this evidence was limited. Healthcare service costs were probably lower, while relatively few studies examined the effects on family caregivers.

These findings do not establish that treating acute illness at home is universally equivalent to inpatient care. They describe outcomes among selected patients receiving care through organized programs within the healthcare systems studied.

A randomized trial published by Shepperd and colleagues in Annals of Internal Medicine in 2021 provides further evidence relevant to older people. The study enrolled 1,055 medically unwell but physiologically stable older adults referred for hospital admission across nine sites in the United Kingdom.

Participants received either admission-avoidance hospital-at-home supported by comprehensive geriatric assessment or conventional hospital care, with comprehensive geriatric assessment when available.

At six months, 78.6% of evaluated participants in the hospital-at-home group and 75.3% in the hospital group were living at home. The difference was not statistically significant. Mortality was also similar, while admission to long-term residential care was less frequent among participants assigned to hospital-at-home.

An important feature of this study was the organization of care. The intervention involved coordinated clinical services supported by geriatric expertise rather than occasional home visits or remote monitoring alone.

Implementation evidence provides another perspective. A 2024 Cochrane qualitative evidence synthesis by Wallis and colleagues included 52 studies from 13 countries. Covering both admission-avoidance and early-discharge services, the review emphasized the importance of professional skills, communication, organizational relationships, patient acceptance and caregiver support.

More recent publications, including a July 2026 discussion in Age and Ageing, continue to highlight substantial variation among hospital-at-home programs. Differences in patient populations, clinical intensity, workforce organization and financing make it difficult to treat every model as the same intervention.

This distinction matters particularly when considering implementation in Viet Nam. Outcomes achieved by a mature, multidisciplinary hospital-at-home service in another country cannot be assumed for a Vietnamese provider offering a different level of treatment, monitoring or emergency support.

The appropriate conclusion is therefore measured. Admission-avoidance hospital-at-home may be an effective alternative to inpatient treatment for selected older people when the service has the clinical capabilities and hospital transfer arrangements required by their conditions.

The evidence supports careful implementation. It does not justify introducing the model as an unrestricted response to hospital overcrowding.

Understanding the Legal Boundaries in Viet Nam

A proposed admission-avoidance hospital-at-home program must be examined within Viet Nam's existing legal framework for medical examination and treatment.

The Law on Medical Examination and Treatment No. 15/2023/QH15, effective principally from January 1, 2024, provides the central framework. Its applicable provisions should be read together with subsequent amendments and implementing regulations, including Consolidated Document No. 26/VBHN-VPQH issued by the Office of the National Assembly on February 26, 2026.

Article 79 regulates khám bệnh, chữa bệnh lưu động, or mobile medical examination and treatment. The activities described include services delivered by healthcare facilities outside the locations specified in their operating licenses, medical examination and treatment at home, health examinations at organizations and certain humanitarian medical activities.

The distinction between these categories matters.

Article 79 establishes conditions concerning the healthcare organization, practitioners, medical equipment, facilities and other requirements appropriate to the scope of the activities performed. The requirement for approval from the competent provincial health authority applies to the categories specified in the law, subject to statutory exceptions. It should not be interpreted as imposing an identical approval process on every individual home visit.

Decree No. 96/2023/NĐ-CP provides additional implementation requirements. Decree No. 148/2025/NĐ-CP, effective July 1, 2025, addresses the delegation and allocation of authority within the health sector, including responsibilities relevant to the approval of specified mobile medical activities.

A provider considering hospital-at-home must therefore identify the legal category applicable to its proposed services, verify that its operating license and professional scope support those activities, and determine whether further approval or administrative procedures are required.

Article 79 should not be interpreted as blanket authorization to provide every form of inpatient-level treatment in a patient's home.

Permission to conduct home visits or specified mobile medical procedures does not automatically authorize an entire acute hospital-at-home episode involving multiple treatments, diagnostic services and ongoing clinical responsibility.

Remote medical examination and treatment presents another important distinction.

Article 80 governs remote medical examination and treatment and related professional support. Circular No. 30/2023/TT-BYT establishes the relevant list of diseases and health conditions eligible for remote medical examination and treatment under the applicable framework.

A hospital-at-home program may combine in-person visits with telephone communication, video consultations and remote physiological monitoring. However, these technologies do not independently expand the legally permitted scope of clinical practice.

Article 61, concerning emergency care within healthcare facilities and prehospital emergency services, is also relevant to arrangements for responding to deterioration and transferring patients for urgent treatment.

A further issue concerns the legal classification of the treatment episode. Vietnamese law distinguishes inpatient treatment, outpatient treatment and other regulated medical activities. Delivering acute care at home does not automatically give the episode the legal status or reimbursement classification of conventional inpatient treatment.

As of October 2026, the legal instruments reviewed do not establish a comprehensive, nationally standardized admission-avoidance hospital-at-home licensing and reimbursement pathway equivalent to those operating in certain international healthcare systems.

This does not mean that every component of home-based acute care is prohibited. It means that the legal basis for each proposed activity, the authority of participating organizations and the professional responsibilities involved must be established before implementation.

For Vietnamese healthcare institutions, the appropriate first step is a documented legal and professional assessment of the actual service model. Where the authorization or classification of a proposed activity remains uncertain, clarification should be obtained from the competent health authority before patient enrollment.

Eligibility Requires Two Separate Clinical Decisions

The first major decision is whether the older patient genuinely requires acute hospital-level treatment.

The second is whether the proposed hospital-at-home service can safely provide that treatment.

Both conditions must be satisfied.

The initial clinical assessment should establish the diagnosis or working diagnosis, illness severity, immediate treatment needs, relevant comorbidities, necessary investigations and likely clinical course. An appropriately qualified clinician must determine whether acute inpatient admission would otherwise be justified.

Only after that decision should the team assess whether the patient's needs fall within the capabilities of the proposed home-based program.

Consider an older person with a selected acute infection requiring professional medication administration, repeated clinical observations and follow-up laboratory testing. If the patient is sufficiently stable, the diagnostic assessment is adequate and an authorized clinical team can reliably deliver the required treatment, hospital-at-home may be considered.

The same patient may be unsuitable if the necessary investigations are unavailable, treatment requirements exceed the team's capabilities or deterioration cannot be recognized and managed promptly.

Eligibility therefore cannot be determined by diagnosis alone.

A condition accepted by an established hospital-at-home service in another country may be inappropriate for a Vietnamese program with different staffing, diagnostic resources or emergency response arrangements.

Chronological age is not an adequate eligibility criterion either. Frailty, cognitive impairment, disability and multiple chronic conditions may affect treatment requirements, communication and the support needed to maintain safety.

These characteristics do not automatically exclude a patient, but they must be considered in relation to the service's actual capabilities.

An older person with cognitive impairment, for example, may still be suitable if communication, lawful decision-making arrangements, medication administration and clinical supervision can be managed appropriately. Someone who cannot reliably describe new symptoms may need more intensive professional assessment or additional support.

The initial evaluation should also consider the expected course of illness. A patient whose condition may deteriorate rapidly may require a level of observation or immediate intervention that the program cannot guarantee.

The final eligibility decision should be documented by an appropriately qualified clinician who understands both the patient's condition and the capabilities of the receiving service.

Eligibility must remain subject to reassessment. A person who was suitable for hospital-at-home when treatment began may later require hospital admission because of clinical deterioration or changes in service availability.

Recognizing When Hospital Treatment Is the Safer Choice

A credible admission-avoidance program must be clear about the circumstances in which hospital-based treatment remains necessary.

Patients with shock, suspected acute stroke requiring time-sensitive intervention, serious acute coronary conditions, major bleeding, severe respiratory compromise or evolving surgical emergencies generally require urgent hospital assessment and treatment.

Other patients may need continuous monitoring, complex procedures or specialist interventions that cannot reasonably be delivered through the proposed home service.

These examples are not a universal exclusion list. Clinical decisions must reflect the patient's condition and the resources available.

Some older patients appear stable during the initial assessment but remain at substantial risk of deterioration. Increasing oxygen requirements, important changes in consciousness, severe physiological abnormalities or rapidly changing treatment needs may indicate that conventional hospital care is safer.

Clinical scores and standardized observations can support assessment, but they cannot replace professional judgment. A favorable early warning score does not independently establish that treatment at home is appropriate.

Each program should define exclusion criteria for the clinical conditions it intends to manage. These criteria should reflect its workforce, diagnostic access, treatment capabilities and ability to respond to deterioration.

The service must also retain the ability to decline a referral when the patient's needs exceed its capabilities.

A decision to admit a patient to hospital should not be regarded as a failure to achieve admission avoidance. In many cases, it is the safest and most appropriate clinical decision.

The Home Environment Must Support Acute Treatment

Medical eligibility is necessary, but it is not sufficient.

The patient's home becomes a location for active clinical treatment, and its characteristics can affect whether care can be delivered safely.

Depending on the treatment plan, the clinical team may need adequate space for examination, safe installation and use of medical equipment, appropriate medication storage, basic hygiene facilities and reliable electricity or communication.

The program should also consider access for healthcare professionals, safe transportation of equipment and supplies, management of medical waste and any infection prevention precautions required by the patient's condition.

The home does not need to resemble a hospital ward. It must, however, support the treatment the service has agreed to provide.

Geography is particularly important in Viet Nam.

An older person living close to a participating hospital may have reliable access to professional visits, diagnostic services and emergency transportation. The same arrangements may be difficult to maintain in a remote community, mountainous area or neighborhood affected by flooding or serious traffic delays.

A hospital-at-home provider should therefore define a realistic geographical coverage area based on actual travel conditions and response capacity rather than administrative boundaries alone.

Communication reliability is another essential consideration. Remote monitoring may support clinical care, but the team must know what happens when a device fails, mobile connectivity is interrupted or the patient cannot respond.

Where frequent or continuous monitoring is clinically necessary, a system that depends on unreliable equipment or communications may be unsuitable.

Someone living alone should not automatically be excluded. Conversely, the presence of family members does not automatically make the home appropriate for acute treatment.

The important question is whether the patient's essential treatment and supervision needs can be met through the professional service and any support that is genuinely available.

Home suitability should therefore be assessed as part of the clinical eligibility decision, not treated as a secondary logistical matter.

Informed Patient Choice and Family Caregiver Support

Hospital-at-home should be offered as a clinically appropriate alternative, not imposed because inpatient beds are scarce or treatment at home appears less expensive.

The patient needs to understand why acute hospital-level treatment is required and how the proposed home-based episode will operate.

This includes the treatments to be delivered, the professionals involved, the expected frequency of clinical assessments, available support outside routine hours and the circumstances that would require hospital transfer.

Patients and families should know how to contact the clinical team, what to do when symptoms change and whether household members are expected to assist with any part of the care arrangement.

For some older people, remaining at home may offer meaningful advantages. Familiar surroundings may be more comfortable, daily routines may be easier to maintain and some disruptions associated with hospitalization may be reduced.

Others may prefer inpatient care because they feel safer with immediate access to healthcare professionals. That preference deserves respect.

The Law on Medical Examination and Treatment contains relevant provisions concerning patient information, choice and refusal of treatment, subject to applicable statutory conditions and exceptions.

Cognitive impairment should not automatically prevent an older person from participating in decisions. When additional communication support, assessment of decision-making ability or legally valid representation is necessary, the relevant requirements must be followed.

The presence of relatives does not automatically authorize them to make medical decisions on the patient's behalf.

Family involvement also needs to be realistic.

Relatives may assist with communication, meals, ordinary daily activities or practical arrangements during treatment. They should not automatically be expected to administer treatments requiring professional qualifications, interpret clinical abnormalities or determine whether hospital transfer is necessary.

Some households have several adults available. Others depend on one caregiver who must balance employment, childcare or personal health needs.

The program should establish what assistance is required, what family members are willing and able to provide, and whether essential clinical needs can be met without transferring inappropriate professional responsibilities to them.

Caregiver burden should remain under review throughout treatment. If essential support becomes unavailable, the responsible clinician must reconsider whether the patient can safely continue receiving acute care at home.

Clinical Accountability Must Remain Clear Throughout the Episode

Admission-avoidance hospital-at-home requires more than a collection of individual services. It needs an identifiable healthcare organization, a defined clinical leadership structure and reliable coordination across the acute treatment episode.

Before accepting a patient, the program must establish which legally authorized organization is responsible for delivering the proposed services and who has authority to make clinical decisions.

An appropriately qualified clinician should be identifiable as responsible for the treatment plan, clinical reassessment and decisions about continuing care at home or arranging hospital transfer.

Other professionals may contribute according to their qualifications, assigned duties and legally permitted scope of practice.

Nurses may undertake authorized clinical observations, medication administration and nursing procedures. Pharmacists may support medication review and medication safety. Laboratory professionals, imaging services and other specialists may become involved when necessary.

Operational coordinators can organize visits, equipment, transportation and communications, but coordination responsibilities should not be confused with clinical authority.

This distinction becomes particularly important when several organizations collaborate.

A hospital may propose retaining responsibility for treatment decisions while another appropriately authorized provider undertakes specified home visits. Such an arrangement requires clarity about the legal basis of the collaboration and the responsibilities assigned to each participating organization.

The team must know who reviews laboratory results, who responds to abnormal observations, who may modify treatment and who makes decisions about hospital transfer.

A commercial agreement between providers does not independently authorize activities beyond their permitted professional scopes.

Availability outside normal working hours is especially important.

Acute illness does not follow office schedules. A patient may deteriorate during the night or need urgent reassessment when the usual clinician is unavailable.

The program must therefore establish professional availability and response arrangements that match the risks of its patients throughout the period for which it has accepted clinical responsibility.

This does not mean that a physician must remain physically present in every patient's home. It means that the service must be able to provide clinically appropriate assessment, decisions and escalation when required.

The 2025 publication Practice Standards for Acute Hospital Care at Home, by Levine and colleagues in the Journal of the American Geriatrics Society, provides a useful international reference.

The authors developed 31 practice standards across seven domains addressing leadership, workforce, professional education, quality improvement, safe practice and clinical protocols.

These are international practice standards rather than mandatory Vietnamese licensing requirements. Their relevance lies in reinforcing that acute hospital-level care at home depends on an organized, professionally accountable clinical service.

Treatment and Monitoring Must Match the Patient's Clinical Needs

Before accepting patients, a hospital-at-home program needs a precise description of the acute care it can deliver.

This should identify the conditions accepted, treatment capabilities, professional workforce, clinical assessment arrangements, diagnostic access and circumstances requiring hospital-based services.

An older patient may need repeated laboratory investigations, medication administration, oxygen therapy or other interventions during an acute episode.

Whether these activities can be provided safely at home depends on the patient's condition, the provider's actual capabilities and the applicable legal requirements.

Medication management illustrates the importance of this assessment.

A home-based acute treatment plan may involve new prescriptions, adjustments to existing medicines or treatments requiring professional administration and monitoring.

The service needs appropriate arrangements for prescribing, dispensing, transportation, storage, administration and clinical review. Where parenteral treatment or another professional procedure is required, the organization must confirm that the activity is authorized, appropriately staffed and feasible in the home environment.

The ability to transport medication to a patient's residence does not, by itself, establish that the treatment can be administered safely there.

Diagnostic services require similar planning.

A laboratory specimen must be collected appropriately, transported and processed. The result must reach the responsible clinician within a clinically acceptable period, and any significant finding must lead to appropriate action.

When imaging or specialist assessment is unavailable at home, the program should determine whether the patient can be transported safely and whether the resulting delay is acceptable.

If a necessary investigation or treatment becomes unavailable, the patient's continued suitability must be reconsidered.

Monitoring is equally important, but monitoring alone does not make hospital-at-home safe.

Physiological measurements, symptom reports and clinical observations are useful only when they are interpreted and connected to clinical decisions.

Some patients require regular in-person examinations. Others may benefit from additional measurements obtained through suitable devices.

The monitoring plan should specify which observations are necessary, how frequently they should be obtained, who reviews the information and what changes require reassessment.

Remote monitoring should not be treated as a universal substitute for professional examination. A normal device reading does not always exclude deterioration, while an abnormal reading requires confirmation and interpretation in the context of the patient's overall condition.

Device accuracy, patient ability to use equipment, communication reliability and timely data review all affect safety.

The program must also have a backup arrangement when the usual monitoring system fails.

Patients and caregivers should understand how to report new or worsening symptoms directly rather than wait for a device to generate an alert.

The measure of an effective monitoring system is not the quantity of information collected. It is whether important clinical changes lead to appropriate action.

Hospital Transfer Must Be Planned Before It Becomes Necessary

Hospital transfer is an expected possibility in admission-avoidance care. It should be designed into the service from the beginning rather than treated as an exceptional event.

A patient who was suitable for home treatment in the morning may need hospital assessment later that evening. The program must be capable of recognizing that change and responding without avoidable delay.

Escalation criteria should be specific to the conditions and treatments covered by the program.

They may include worsening respiratory symptoms, significant changes in consciousness, concerning physiological observations, unexpected complications or failure to respond to treatment.

The response must reflect clinical urgency.

Some changes may require prompt professional reassessment and treatment adjustment. Others require emergency assistance and immediate hospital transfer.

The escalation pathway should identify who receives the concern, who assesses the clinical situation, who makes the transfer decision and how transportation will be arranged.

Clinical decision-making and transport coordination are related but distinct responsibilities. A decision that hospital admission is necessary does not complete the process if the patient cannot reach appropriate care in time.

When a life-threatening emergency occurs, emergency medical assistance should be activated without delay.

In Viet Nam, 115 is the medical emergency number, although prehospital emergency response capacity and ambulance availability vary between localities. A hospital-at-home program must verify the practical emergency arrangements within its coverage area.

Where a sponsoring or receiving hospital is involved, arrangements should be agreed upon before patients enter the program.

The service should identify the expected transfer destination, communication process, transportation arrangements and alternatives if the usual receiving facility cannot accept the patient.

The clinical handover should include the acute diagnosis or working diagnosis, relevant medical history, treatments delivered at home, recent clinical observations, investigation results and the reason hospital care is required.

The patient should not have to reconstruct the treatment history during an emergency department consultation.

The program should also define and monitor response expectations appropriate to its clinical scope.

The important question is how reliably the service can move from recognizing deterioration to obtaining the necessary clinical assessment or intervention.

An unplanned transfer does not necessarily indicate poor performance. Recognizing that hospital treatment has become necessary and arranging timely transfer may demonstrate that the safety system is working.

The greater concern is deterioration that was not recognized, a transfer decision made too late or a patient unable to access necessary hospital treatment.

A hospital-at-home service should never depend on the assumption that patients will remain stable until the next scheduled visit.

Financial Arrangements and Data Governance

The financial case for admission-avoidance hospital-at-home needs to be examined carefully in the Vietnamese context.

International evidence suggests that appropriately organized programs may reduce certain healthcare service costs. However, those findings depend on staffing, treatment intensity, transportation, equipment, diagnostics and the financing arrangements of the healthcare systems studied.

Delivering acute care at home can involve substantial operating costs.

Skilled professional visits, clinical coverage, medication administration, diagnostic testing, remote monitoring and emergency transportation must all be considered.

Some costs may also be shifted to patients and their families unless the financial model addresses them explicitly.

Viet Nam's health insurance framework is evolving in this area.

In August 2026, the Ministry of Health published a draft circular proposing health insurance payment arrangements for family medicine, home-based medical examination and treatment, and remote medical services. Consultation activities on the draft were continuing in October 2026.

This is a relevant policy development, but a draft proposal should not be presented as an effective reimbursement rule. Nor should proposed coverage for individual home-based healthcare services be interpreted as automatic authorization or reimbursement for an entire admission-avoidance hospital-at-home episode.

The actual payment arrangements must be assessed against the rules in force when the service is delivered, including the provider's legal authorization, applicable service classifications, payment conditions and contractual requirements.

Patients should receive clear information about expected services, charges, payment responsibilities and potential additional costs before treatment begins whenever possible.

At the organizational level, financial planning must account for clinical supervision, backup arrangements and hospital transfer capability.

These are essential safety requirements, not optional expenses that can be removed simply to make the service appear less costly.

Clinical documentation and information governance also require attention.

The acute episode should have coherent records showing eligibility assessment, treatment orders, professional observations, investigations, clinical decisions, communications and any escalation.

Where several providers collaborate, necessary information should be accessible to authorized professionals without creating unnecessary disclosure of personal health information.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, effective from January 1, 2026, provide an important framework for personal data processing.

Decree No. 102/2025/NĐ-CP on healthcare data management is also relevant to digital health data handled within its scope.

A service using remote monitoring or electronic clinical communication should establish an appropriate legal basis for processing and sharing patient information, suitable access controls, secure communication arrangements and procedures for responding to data-related incidents.

Digital tools should strengthen clinical accountability, not create additional uncertainty about who is responsible for patient information or treatment decisions.

Every Acute Episode Needs a Defined End Point

Admission-avoidance hospital-at-home should have a clearly defined clinical purpose and an appropriate end point.

The patient enters the program because active acute treatment would otherwise require hospital admission.

The episode should conclude when the acute condition has improved sufficiently for less intensive care, or when the patient's condition requires transfer to a hospital.

An appropriately qualified clinician should make that decision based on the patient's current clinical needs rather than an arbitrary number of days.

Some patients may complete treatment and return to routine outpatient follow-up. Others may need home nursing, rehabilitation or additional assistance with daily activities after acute treatment has ended.

These services may be important, but they have different purposes and should not be confused with admission-avoidance hospital-at-home.

Before the acute episode ends, the clinical team should review the patient's condition, medication plan, outstanding investigations, potential complications and follow-up requirements.

The patient and relevant caregivers should understand what treatment has been completed, what further care is needed and which service will assume responsibility.

Where another healthcare provider will continue care, an appropriate clinical handover should be arranged.

A clear endpoint helps prevent hospital-at-home from becoming an undefined combination of acute treatment, recovery support and routine home care.

Beginning With a Carefully Bounded Vietnamese Pilot

For Viet Nam, a reasonable implementation approach would be a narrowly defined, clinically governed pilot undertaken by a healthcare organization with the necessary legal authority and demonstrated operational capacity.

The first task is not purchasing monitoring technology or announcing the availability of hospital-at-home beds.

It is establishing exactly which acute clinical services the organization intends to provide, which patients may be eligible and whether the proposed activities can lawfully and safely be delivered.

The institution should undertake a formal assessment of the service model, including its legal basis, operating license, professional scope, staffing, treatment procedures, diagnostic access and organizational partnerships.

The initial patient population should be deliberately limited.

A pilot might focus on one selected acute condition or a small group of conditions for which the participating clinicians have suitable expertise and dependable treatment pathways.

The program should not begin by accepting every older person who might otherwise require hospitalization.

Eligibility criteria, clinical exclusion criteria and treatment protocols should be agreed upon before enrollment.

The program must also determine who performs the initial assessment, who accepts clinical responsibility, how treatment will be delivered and what circumstances require hospital transfer.

Staffing and response arrangements should be tested against the conditions the program intends to manage.

A service that performs well during routine working hours but cannot respond appropriately to deterioration at night may not be suitable for certain acute illnesses.

Medication supply, laboratory testing, equipment, clinical communication and emergency transportation should be verified before the first patient is accepted.

Simulation exercises can help identify operational weaknesses.

The team might rehearse what happens when a patient deteriorates unexpectedly, a clinically important laboratory result becomes available after hours, a monitoring device fails or an ambulance cannot arrive within the expected period.

Staff should understand their responsibilities, the limits of their permitted professional activities and the procedures for obtaining additional clinical support.

The pilot should begin conservatively, with regular multidisciplinary review of eligibility decisions, treatment delivery, clinical outcomes and transfers.

A small number of successful cases should not automatically justify rapid expansion.

The organization needs evidence that the service can perform reliably across different shifts, clinical situations and foreseeable operating conditions.

If a proposed pilot involves clinical research or a new technique or method subject to additional regulatory requirements, the institution must separately determine the applicable approval and ethical review obligations. Describing an activity as a pilot does not remove those responsibilities.

Expansion should follow demonstrated clinical safety, legal compliance and operational readiness.

Measuring Quality Without Encouraging Inappropriate Admission Avoidance

The success of hospital-at-home should not be measured simply by the number of inpatient admissions avoided.

Such a measure could create pressure to accept unsuitable patients or delay necessary hospital transfers.

Quality evaluation should begin with the appropriateness of patient selection.

The program should examine whether accepted patients genuinely required hospital-level acute treatment and whether the documented assessment supported safe delivery at home.

Treatment reliability is another important consideration.

Relevant questions include whether planned clinical assessments occurred, necessary medicines and procedures were delivered, required investigations were completed and significant findings received timely professional review.

The response to deterioration deserves particular attention.

A program should examine whether worsening conditions were recognized, whether decisions were timely and whether necessary hospital transfers could be arranged without avoidable delay.

Transfers should be reviewed in their clinical context rather than automatically classified as adverse outcomes.

In some circumstances, a timely transfer demonstrates that the service has correctly recognized the limits of home-based treatment.

Clinical outcomes may include mortality, complications, adverse events, subsequent hospital utilization and functional status, interpreted according to the conditions treated and the characteristics of the patient population.

Patient experience and caregiver burden are also important.

Some older people may value remaining in familiar surroundings, while others may find repeated visits, medical equipment or uncertainty about emergency access stressful.

Families may experience practical benefits, but they may also take on additional responsibilities.

The program should assess these experiences directly rather than assume that home treatment is always preferred.

Financial evaluation should consider the resources used by the provider and any costs transferred to patients and families.

Comparisons with conventional inpatient care must account for differences in illness severity, patient selection and the services delivered.

Access and fairness should also be considered.

Strict geographical or household eligibility requirements may be necessary for safety, but they can create barriers for older people living alone, those with limited resources or those residing farther from participating hospitals.

These consequences should be understood when evaluating whether the service is appropriate for broader implementation.

Quality improvement should involve regular multidisciplinary review of adverse events, delayed assessments, equipment failures, communication problems and situations in which care did not proceed as expected.

These are proposed areas for local quality evaluation, not a nationally mandated Vietnamese hospital-at-home accreditation framework.

The objective is to determine whether the program consistently provides appropriate acute treatment and maintains reliable access to hospital care when required.

Building a Safe Alternative to Hospital Admission

Admission-avoidance hospital-at-home offers an important possibility for selected older people: receiving necessary acute treatment in familiar surroundings while remaining under the responsibility of an organized clinical service.

The international evidence supports this possibility, but within clearly defined limits.

Favorable outcomes have been demonstrated among selected patients receiving care through established programs with appropriate clinical capabilities. Those results cannot be assumed for every condition, provider or healthcare setting.

For Viet Nam, the opportunity should be approached as a carefully governed service innovation rather than a simple extension of ordinary home care or a technology-based substitute for inpatient beds.

Patient selection must begin with a professional determination that acute hospital-level treatment is needed, followed by a separate assessment of whether the proposed home-based service can provide that treatment safely.

The patient's home environment and geographical location must support the care required. The patient must make an informed choice, and family involvement must remain appropriate and voluntary.

The provider must have the necessary legal authority, professional workforce, diagnostic resources and treatment capabilities.

Clinical responsibility must remain identifiable throughout the episode, with monitoring connected to timely decisions and hospital transfer available when further treatment becomes necessary.

A well-designed program does not try to keep every patient at home. It recognizes when circumstances have changed and when the resources of a conventional hospital are necessary.

For Viet Nam, the most promising path is careful development through legally appropriate, clinically governed services, beginning with limited patient populations and expanding only when safety and performance can be demonstrated.

The success of admission-avoidance hospital-at-home should not be defined by how many hospital beds remain unused. It should be defined by whether each older patient receives the right level of acute treatment, with clear clinical responsibility and timely access to hospital care whenever necessary.

That is the standard against which the model should be developed, evaluated and, where appropriate, expanded.

References

1. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. Adopted January 9, 2023; principally effective January 1, 2024, as amended. See also Office of the National Assembly, Consolidated Document No. 26/VBHN-VPQH, February 26, 2026.

2. Government of Viet Nam. Decree No. 96/2023/NĐ-CP Detailing Certain Provisions of the Law on Medical Examination and Treatment. December 30, 2023, as amended.

3. Government of Viet Nam. Decree No. 148/2025/NĐ-CP on Decentralization and Delegation of Authority in the Health Sector. June 12, 2025; effective July 1, 2025.

4. Ministry of Health of Viet Nam. Circular No. 30/2023/TT-BYT on the List of Diseases and Health Conditions Eligible for Remote Medical Examination and Treatment. December 30, 2023; effective January 1, 2024.

5. National Assembly of Viet Nam. Law on Health Insurance No. 25/2008/QH12, as amended. See also Office of the National Assembly, Consolidated Document No. 40/VBHN-VPQH, March 16, 2026.

6. Ministry of Health of Viet Nam. Draft Circular on Health Insurance Payment for Family Medicine, Home-Based Medical Examination and Treatment, and Remote Medical Services. Public consultation materials, August–October 2026. Draft proposal, not an enacted regulation.

7. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. Adopted June 26, 2025; effective January 1, 2026.

8. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Certain Provisions and Measures for Implementing the Law on Personal Data Protection. December 31, 2025; effective January 1, 2026.

9. Government of Viet Nam. Decree No. 102/2025/NĐ-CP on Healthcare Data Management. May 13, 2025; effective July 1, 2025.

10. Edgar K, Iliffe S, Doll HA, Clarke MJ, Gonçalves-Bradley DC, Wong E, Shepperd S. Admission avoidance hospital at home. Cochrane Database of Systematic Reviews. 2024;(3). DOI: 10.1002/14651858.CD007491.pub3.

11. Shepperd S, Butler C, Cradduck-Bamford A, et al. Is comprehensive geriatric assessment admission avoidance hospital at home an alternative to hospital admission for older persons? A randomized trial. Annals of Internal Medicine. 2021;174(7):889–898. DOI: 10.7326/M20-5688.

12. Wallis JA, Shepperd S, Makela P, et al. Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews. 2024;(3). DOI: 10.1002/14651858.CD014765.pub2.

13. Levine DM, DeCherrie LV, Siu A, et al. Practice standards for acute hospital care at home. Journal of the American Geriatrics Society. 2025;73(7):2037–2045. DOI: 10.1111/jgs.19427.

14. Vardy ERLC, Masoli JAH. Hospital at Home—What does the evidence tell us? Age and Ageing. 2026;55(7). DOI: 10.1093/ageing/afag208.