Prevalence and Characterization of Yoga Mentions in the Electronic Health Record

Abstract

Background: There is a growing patient population using yoga as a therapeutic intervention, but little is known about how yoga interfaces with health care in clinical settings. Purpose: To characterize how yoga is documented at a large academic medical center and to systematically identify clinician-derived therapeutic use cases of yoga. Methods: We designed a retrospective observational study using a yoga cohort (n ‫؍‬ 30,976) and a demographically matched control cohort (n ‫؍‬ 92,919) from the electronic health records at Penn Medicine between 2006 and 2016. We modeled the distribution of yoga notes among patients, clinicians, and clinical service departments, built a multinomial Naïve Bayes classifier to separate the notes by contextdependent use of the word yoga, and modeled associations between clinician recommendations to use yoga and 754 diagnostic codes with Fisher's exact test, setting an false discovery rate (FDR)-adjusted P-value < .05 (ie, q-value) as the significance threshold. Results: Yoga mentions in the electronic health record have increased 10.4-fold during the 10-year study period, with 2.6% of patients having at least 1 mention of yoga in their notes. In total, 30,976 patients, 2398 clinicians, and 41 clinical service departments were affiliated with yoga notes. The majority of yoga notes are in primary care. Nine diagnoses met the significance criteria for having an association with clinician recommendations to use yoga including Parkinson's disease (Odds ratio [OR], 6.3 [3.7 to 11.4]; q-value < 0.001), anxiety (OR, 5.8 [3.8 to 9.0]; q-value < 0.001), and backache (OR, 3.8 [2.4 to 6.3]; q-value ‫؍‬ 0.001). Conclusions: There is a widespread and growing trend to include yoga as part of the clinical record. In practice, clinicians are recommending yoga as a nonpharmacological intervention for a subset of common chronic diseases.

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