Measuring the Response Performance of U.S. States against COVID-19 Using an Integrated DEA, CART, and Logistic Regression Approach.

Measuring the U.S.'s COVID-19 response performance is an extremely important challenge for health care policymakers. This study integrates Data Envelopment Analysis (DEA) with four different machine learning (ML) techniques to assess the efficiency and evaluate the U.S.'s COVID-19 response performance. First, DEA is applied to measure the efficiency of fifty U.S. states considering four inputs: number of tested, public funding, number of health care employees, number of hospital beds. Then, number of recovered from COVID-19 as a desirable output and number of confirmed COVID-19 cases as a undesirable output are considered. In the second stage, Classification and Regression Tree (CART), Boosted Tree (BT), Random Forest (RF), and Logistic Regression (LR) were applied to predict the COVID-19 response performance based on fifteen environmental factors, which were classified into social distancing, health policy, and socioeconomic measures. The results showed that 23 states were efficient with an average efficiency score of 0.97. Furthermore, BT and RF models produced the best prediction results and CART performed better than LR. Lastly, urban, physical inactivity, number of tested per population, population density, and total hospital beds per population were the most influential factors on efficiency.